Provider Demographics
NPI:1003051475
Name:JOHNSON, JASON PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1819 BROADWAY ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5671
Mailing Address - Country:US
Mailing Address - Phone:281-993-9333
Mailing Address - Fax:281-993-0634
Practice Address - Street 1:1819 BROADWAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5670
Practice Address - Country:US
Practice Address - Phone:281-993-9333
Practice Address - Fax:281-993-0634
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB149654Medicare PIN