Provider Demographics
NPI:1144280512
Name:MAGONE, RANDOLPH AARON (DC)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:AARON
Last Name:MAGONE
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:UNIVERSITY CHIROPRACTIC
Mailing Address - Street 2:346 THIRD STREET
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419
Mailing Address - Country:US
Mailing Address - Phone:724-330-5185
Mailing Address - Fax:724-330-5187
Practice Address - Street 1:UNIVERSITY CHIROPRACTIC
Practice Address - Street 2:346 THIRD STREET
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419
Practice Address - Country:US
Practice Address - Phone:724-330-5185
Practice Address - Fax:724-330-5187
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006269L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
793426Medicare ID - Type Unspecified
U57479Medicare UPIN