Active NPI
Amanda Randall, D.C.
- Chiropractor
- Wolcott, NY
National Provider Identifier
1295150357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 012484
- Practice address
- 12007 E Main St
Wolcott, NY 14590-1021 - Phone
- (315) 905-4077
- Fax
- (315) 905-4102
- NPI assigned
- Feb 26, 2014
- Last updated
- May 11, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 012484 | NY | Primary |
Addresses
Primary practice location
12007 E Main St
Wolcott, NY 14590-1021
Mailing address
12007 E Main St
Wolcott, NY 14590-1021
Phone (315) 905-4077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150105001324 | NY | Practitioner - Chiropractic | 5799008470 | Practice locations: Wolcott, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683763200000",
"number": "1295150357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12007 E MAIN ST",
"city": "WOLCOTT",
"state": "NY",
"postal_code": "145901021",
"telephone_number": "315-905-4077",
"fax_number": "315-905-4102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12007 E MAIN ST",
"city": "WOLCOTT",
"state": "NY",
"postal_code": "145901021",
"telephone_number": "315-905-4077",
"fax_number": "315-905-4102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "AMANDA",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-26",
"last_updated": "2023-05-11",
"certification_date": "2023-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "012484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wolcott, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.