Provider Demographics
NPI:1235292558
Name:HAAS, RANDALL MARSHALL (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MARSHALL
Last Name:HAAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:STE 405
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1473
Mailing Address - Country:US
Mailing Address - Phone:904-260-1993
Mailing Address - Fax:904-260-6452
Practice Address - Street 1:11481 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 405
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-1473
Practice Address - Country:US
Practice Address - Phone:904-260-1993
Practice Address - Fax:904-260-6452
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050777600Medicaid
FL050777600Medicaid