Provider Demographics
NPI:1083855977
Name:JOHNSON, AMANDA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:LAWLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1605 N PENN AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-2137
Mailing Address - Country:US
Mailing Address - Phone:620-331-3600
Mailing Address - Fax:
Practice Address - Street 1:1605 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-2137
Practice Address - Country:US
Practice Address - Phone:620-331-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor