Provider Demographics
NPI:1063859668
Name:LAWRENCE A JOHNSON DC PC
Entity Type:Organization
Organization Name:LAWRENCE A JOHNSON DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-248-4960
Mailing Address - Street 1:90 JERICHO TPKE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1845
Mailing Address - Country:US
Mailing Address - Phone:516-248-4960
Mailing Address - Fax:516-248-4962
Practice Address - Street 1:90 JERICHO TPKE
Practice Address - Street 2:SUITE 6
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1845
Practice Address - Country:US
Practice Address - Phone:516-248-4960
Practice Address - Fax:516-248-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty