Randy D. Modglin, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC0000001352 Issued in TN

Practice address

306 Sunset Dr
Ste 100
Johnson City, TN 37604-2492

Phone

(423) 926-8304

Fax

(423) 926-5976

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 8

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spinal Corrective CtrGroup PAC ID 9931592219, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Spinal Corrective Ctr

  • Chiropractor
  • Johnson City, TN
  • NPI 1093336448
  Medicare reassignment Care Compare group NPD
• DRB Consulting Services, LLC

  • Chiropractor
  • Johnson City, TN
  • NPI 1518583731
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598227200000",
    "number": "1932258191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 SUNSET DR STE 100",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042492",
            "telephone_number": "423-926-8304",
            "fax_number": "423-926-5976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 SUNSET DR",
            "address_2": "STE 100",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042492",
            "telephone_number": "423-926-8304",
            "fax_number": "423-926-5976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODGLIN",
        "first_name": "RANDY",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "TN",
            "license": "DC0000001352",
            "primary": false
        },
        {
            "code": "111NR0200X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Radiology",
            "state": "TN",
            "license": "DC0000001352",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TN",
            "license": "1352",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "TN",
            "license": "DC0000001352",
            "primary": false
        },
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "TN",
            "license": "DC0000001352",
            "primary": false
        },
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "TN",
            "license": "DC0000001352",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "TN",
            "license": "DC0000001352T",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TN",
            "license": "DC0000001352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3074458",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350052904",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria S. Mitchell, RN
• Justin T Mizelle, PA-C
• Susan Mizelle, PA
• Dianna Nicole Mock, APRN
• Homayoun Modarresifar, MD
• Abdallah Mohamed, MD
• Khalid Mohamed Hamadelneel Mohamed, MD
• Hugh Charles Mohler, D.D.S.
• Mohammad Mona, OD
• Rachel Monderer, MD

• Chiropractor in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Chiropractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (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.