Provider Demographics
NPI:1083814065
Name:JOHNSON CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:Z
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:304-422-1191
Mailing Address - Street 1:706 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5658
Mailing Address - Country:US
Mailing Address - Phone:304-422-1191
Mailing Address - Fax:304-428-5488
Practice Address - Street 1:706 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5658
Practice Address - Country:US
Practice Address - Phone:304-422-1191
Practice Address - Fax:304-428-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty