Provider Demographics
NPI:1083022933
Name:JOHNSON, YVETTE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 NAPLES PLAZA
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3209
Mailing Address - Country:US
Mailing Address - Phone:562-810-4916
Mailing Address - Fax:
Practice Address - Street 1:5855 E NAPLES PLZ
Practice Address - Street 2:SUITE 113
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5060
Practice Address - Country:US
Practice Address - Phone:562-810-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor