Active NPI
Randal Joseph Jacklitch, D.C.
- Chiropractor
- Paynesville, MN
National Provider Identifier
1447201561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2434
- Practice address
- 645 Lake Ave S
Paynesville, MN 56362-1736 - Phone
- (320) 243-7412
- Fax
- (320) 243-7170
- NPI assigned
- May 13, 2006
- 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 | 2434 | MN | Primary |
Addresses
Primary practice location
645 Lake Ave S
Paynesville, MN 56362-1736
Mailing address
208 W James St
P.O. Box 79
Paynesville, MN 56362-1219
Phone (320) 243-7412
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 |
|---|---|---|---|
| 2434 | MN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472601600000",
"number": "1447201561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 W JAMES ST",
"address_2": "P.O. BOX 79",
"city": "PAYNESVILLE",
"state": "MN",
"postal_code": "563621219",
"telephone_number": "320-243-7412",
"fax_number": "320-243-7170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 LAKE AVE S",
"city": "PAYNESVILLE",
"state": "MN",
"postal_code": "563621736",
"telephone_number": "320-243-7412",
"fax_number": "320-243-7170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKLITCH",
"first_name": "RANDAL",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-13",
"last_updated": "2016-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "2434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paynesville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.