Provider Demographics
NPI:1730619081
Name:MATULKA, RANDALL (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:MATULKA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:MATULKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1623 E 4TH AVE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-5109
Mailing Address - Country:US
Mailing Address - Phone:813-248-2900
Mailing Address - Fax:813-248-2933
Practice Address - Street 1:1623 E 4TH AVE UNIT 106
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-5109
Practice Address - Country:US
Practice Address - Phone:813-248-2900
Practice Address - Fax:813-248-2933
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor