Provider Demographics
NPI:1083694566
Name:JOHNSTON, RICKY J (DC)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:J
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 1:216 N ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2537
Mailing Address - Country:US
Mailing Address - Phone:509-529-6200
Mailing Address - Fax:509-529-6200
Practice Address - Street 1:216 N ROOSEVELT
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2537
Practice Address - Country:US
Practice Address - Phone:509-529-6200
Practice Address - Fax:509-529-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02496Medicare UPIN
WAG001300234Medicare PIN