Provider Demographics
NPI:1548253156
Name:DECKER, RANDOLPH ROY (DC)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:ROY
Last Name:DECKER
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 1:16312 N 69 HWY
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-9754
Mailing Address - Country:US
Mailing Address - Phone:816-630-1029
Mailing Address - Fax:
Practice Address - Street 1:1000 N JESSE JAMES RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1244
Practice Address - Country:US
Practice Address - Phone:816-630-6211
Practice Address - Fax:816-630-6211
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPO0058846OtherRAILROAD MEDICARE
MO12330027OtherBLUE CROSS BLUE SHIELD KC
MO4400182OtherUNITED HEALTH CARE
MO4401828OtherAETNA
KS532434OtherKANSAS BLUE CROSS
MO2032917OtherCIGNA
MO000Medicaid
MOT73784OtherHUMANA
KS532434OtherKANSAS BLUE CROSS
MO2032917OtherCIGNA