1598902918 NPI number — RANDALL M. HAAS, DC PA

Table of content: (NPI 1568459576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598902918 NPI number — RANDALL M. HAAS, DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDALL M. HAAS, DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAAS FAMILY CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598902918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11481 OLD SAINT AUGUSTINE RD STE 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32258-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-260-1993
Provider Business Mailing Address Fax Number:
904-260-6452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11481 OLD SAINT AUGUSTINE RD STE 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32258-1475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-260-1993
Provider Business Practice Location Address Fax Number:
904-260-6452
Provider Enumeration Date:
01/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAAS
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-260-1993

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)