Provider Demographics
NPI:1114330016
Name:JOHNSON, JOSHUA EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1760
Mailing Address - Country:US
Mailing Address - Phone:765-482-8181
Mailing Address - Fax:765-482-8183
Practice Address - Street 1:1111 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1760
Practice Address - Country:US
Practice Address - Phone:765-482-8181
Practice Address - Fax:765-482-8183
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002779A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor