Randall    Haas    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004083
NPI
1235292558
Tax ID
591995321
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
11481 Old St. Augustine Road Suite 405
Jacksonville, FL 32258
United States
County
Duval
Phone
9042601993 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address