Provider Demographics
NPI:1093855611
Name:JOHNSON, CAROL CALDWELL (DC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:CALDWELL
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 1:1535 W NORTHFIELD BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1427
Mailing Address - Country:US
Mailing Address - Phone:615-849-9064
Mailing Address - Fax:615-849-7744
Practice Address - Street 1:1535 W NORTHFIELD BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1427
Practice Address - Country:US
Practice Address - Phone:615-849-9064
Practice Address - Fax:615-849-7744
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU30190Medicare UPIN
TN3676255Medicare ID - Type Unspecified