Provider Demographics
NPI:1063449163
Name:JOHNSON, DAVID J (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
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 1:7322 SUNSHINE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2253
Mailing Address - Country:US
Mailing Address - Phone:813-884-6330
Mailing Address - Fax:813-884-5520
Practice Address - Street 1:5511 HANLEY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4903
Practice Address - Country:US
Practice Address - Phone:813-885-7580
Practice Address - Fax:813-884-5520
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0002201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89719Medicare ID - Type Unspecified