Provider Demographics
NPI:1790882330
Name:JOHNS, RANDALL (DC)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:JOHNS
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 1:3316 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0703
Mailing Address - Country:US
Mailing Address - Phone:866-933-1381
Mailing Address - Fax:972-704-2886
Practice Address - Street 1:3316 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0703
Practice Address - Country:US
Practice Address - Phone:866-933-1381
Practice Address - Fax:972-704-2886
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00199466OtherMEDICARE RAILROAD
TX8S3180OtherBCBS
TXP00199466OtherMEDICARE RAILROAD
TXU95560Medicare UPIN