Provider Demographics
NPI:1902880610
Name:WORTHINGTON, RANDY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 WILD GOOSE CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4521
Mailing Address - Country:US
Mailing Address - Phone:530-941-1413
Mailing Address - Fax:530-232-0202
Practice Address - Street 1:869 WILD GOOSE CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4521
Practice Address - Country:US
Practice Address - Phone:530-941-1413
Practice Address - Fax:530-232-0202
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0240360Medicare ID - Type Unspecified
CAU58538Medicare UPIN