Provider Demographics
NPI:1700868171
Name:EBLING, RANDALL LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEE
Last Name:EBLING
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 1:209 W BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-4022
Mailing Address - Country:US
Mailing Address - Phone:561-732-1540
Mailing Address - Fax:561-732-1540
Practice Address - Street 1:209 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-4022
Practice Address - Country:US
Practice Address - Phone:561-732-1540
Practice Address - Fax:561-732-1540
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380563800Medicaid
FLT56401Medicare UPIN
FL89957Medicare ID - Type Unspecified