Randy A Mauldin, DC – Chiropractor

Key facts

NPI: 1326129552
Entity type: Individual (NPI type 1)
Primary specialty: Chiropractor 111N00000X
License: B01055 (NV)
Practice address: 263 Spring Valley Pkwy
Suite E
Spring Creek, NV 89815-6828
Phone: (775) 753-9395
Fax: (775) 753-5921
NPI assigned: Oct 17, 2006
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Bryan a. Baetens, D.C., P.C. Chiropractor · Saint Clair Shores, MI · NPI 1477607679

NPD (past) CHIROPRACTOR

Medicare Care Compare profile

Specialty: Chiropractic
Education: Palmer College Chiropractic - West Sunnyvale, 2001
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

263 Spring Valley Pkwy
Suite E
Spring Creek, NV 89815-6826

263 Spring Valley Pkwy E
Spring Creek, NV 89815-6826
Phone (775) 753-9395

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NV

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20150429000722	NV	Practitioner - Chiropractic	7012933260	Practice locations: Spring Creek, NV

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
B01055	NV	MD	Chiropractor

Practice roles (1 of 2)

Organization	Specialty	Status	New patients
Bryan a. Baetens, D.C., P.C.	Chiropractor	Past since Feb 2, 1995	Accepting new patients

Networks

UT PPO

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor	111N00000X	B01055	NV	Yes

Addresses

Primary practice location

263 Spring Valley Pkwy
Suite E
Spring Creek, NV 89815-6828

Mailing address

263 Spring Valley Pkwy
Suite E
Spring Creek, NV 89815-6828
Phone (775) 753-9395

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 26, 2020.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1326129552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 SPRING VALLEY PKWY",
            "address_2": "SUITE E",
            "city": "SPRING CREEK",
            "state": "NV",
            "postal_code": "898156828",
            "telephone_number": "775-753-9395",
            "fax_number": "775-753-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 SPRING VALLEY PKWY",
            "address_2": "SUITE E",
            "city": "SPRING CREEK",
            "state": "NV",
            "postal_code": "898156828",
            "telephone_number": "775-753-9395",
            "fax_number": "775-753-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAULDIN",
        "first_name": "RANDY",
        "middle_name": "A",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NV",
            "license": "B01055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Creek, NV

All providers in Spring Creek, NV · Chiropractor in Nevada

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.