Provider Demographics
NPI:1114198090
Name:BENJAMIN D JOHNSON, CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:BENJAMIN D JOHNSON, CHIROPRACTIC, INC
Other - Org Name:ALOSTA CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-335-4597
Mailing Address - Street 1:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-1619
Mailing Address - Country:US
Mailing Address - Phone:626-335-4597
Mailing Address - Fax:626-963-9511
Practice Address - Street 1:849 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3603
Practice Address - Country:US
Practice Address - Phone:626-335-4597
Practice Address - Fax:626-963-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15470111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7906627Medicaid
CA7906627Medicaid
CAU04906Medicare PIN