Provider Demographics
NPI:1073739678
Name:JOHNSON, GREGORY EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EUGENE
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 1:363 N SAM HOUSTON PKWY E
Mailing Address - Street 2:STE 1100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2404
Mailing Address - Country:US
Mailing Address - Phone:281-405-2611
Mailing Address - Fax:
Practice Address - Street 1:363 N SAM HOUSTON PKWY E
Practice Address - Street 2:STE 1100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2404
Practice Address - Country:US
Practice Address - Phone:281-405-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02810111N00000X
CADC17722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT14063Medicare UPIN
CADC0177220Medicare ID - Type Unspecified