Provider Demographics
NPI:1033279872
Name:JOHNSON, DARRELL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-1029
Mailing Address - Country:US
Mailing Address - Phone:865-992-7000
Mailing Address - Fax:865-992-7001
Practice Address - Street 1:110 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807
Practice Address - Country:US
Practice Address - Phone:865-992-7000
Practice Address - Fax:865-992-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3972760Medicaid
TN5412749OtherCIGNA ID
TN4043494OtherBLUE SHIELD ID
TN648483OtherUNITED ID
TNU92017Medicare UPIN
TN3972760Medicaid