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General NPI Number Information
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NPI Number | 1790882330
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Entity Type | Individual
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Provider Name | RANDALL JOHNS DC
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Gender | Male
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 3316 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0703
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Country | US
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Telephone | 866-933-1381
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Fax | 972-704-2886
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Provider Business Mailing Address
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Address Line | 3316 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0703
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Country | US
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Telephone | 866-933-1381
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Fax | 972-704-2886
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9359
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License Number State | TX
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