Provider Demographics
NPI:1073988176
Name:JOHNSTON, WILLIAM R (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:JOHNSTON
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 1:2 MARYLAND FARMS
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5007
Mailing Address - Country:US
Mailing Address - Phone:615-435-9139
Mailing Address - Fax:
Practice Address - Street 1:2 MARYLAND FARMS
Practice Address - Street 2:SUITE 120
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5007
Practice Address - Country:US
Practice Address - Phone:615-435-9139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor