Provider Demographics
NPI:1104031715
Name:JOHNSON, LORRAINE MONICA (DC)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:MONICA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LORRAINE
Other - Middle Name:MONICA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:20460 HARVEST AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1111
Mailing Address - Country:US
Mailing Address - Phone:562-335-6727
Mailing Address - Fax:
Practice Address - Street 1:11911 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701-4065
Practice Address - Country:US
Practice Address - Phone:562-809-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor