Active NPI
Randy Lynn Willoughby, D.C.
- Chiropractor
- Melcher, IA
National Provider Identifier
1407977929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- AO5997
- Practice address
- 115A South Main Street
Box 471
Melcher, IA 50163-0471 - Phone
- (641) 947-2068
- Fax
- (641) 947-2068
- NPI assigned
- Apr 2, 2007
- Sex
- Male
- 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 | AO5997 | IA | Primary |
Addresses
Primary practice location
115A South Main Street
Box 471
Melcher, IA 50163-0471
Mailing address
115A South Main St.
Box 471
Melcher, IA 50163-0471
Phone (641) 947-2068
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1147876 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AO5997 | IA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1407977929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115A SOUTH MAIN ST.",
"address_2": "BOX 471",
"city": "MELCHER",
"state": "IA",
"postal_code": "501630471",
"telephone_number": "641-947-2068",
"fax_number": "641-947-2068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115A SOUTH MAIN STREET",
"address_2": "BOX 471",
"city": "MELCHER",
"state": "IA",
"postal_code": "501630471",
"telephone_number": "641-947-2068",
"fax_number": "641-947-2068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLOUGHBY",
"first_name": "RANDY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IA",
"license": "AO5997",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1147876",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melcher, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.