Provider Demographics
NPI:1033144324
Name:JOHNSON, JOHN BARNETTE III (MS DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BARNETTE
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MS DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 LARKIN AVENUE SUITE 103
Mailing Address - Street 2:JOHN B JOHNSON
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-888-2112
Mailing Address - Fax:847-888-0220
Practice Address - Street 1:2000 LARKIN AVENUE SUITE 103
Practice Address - Street 2:JOHN B JOHNSON
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-888-2112
Practice Address - Fax:847-888-0220
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038004583Medicaid
IL004582060OtherBCBS
T37881Medicare UPIN
IL038004583Medicaid