Provider Demographics
NPI:1144429945
Name:JOHNSON CHIROPRACTIC HEALTH AND WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC HEALTH AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC FASA
Authorized Official - Phone:580-338-2070
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-0161
Mailing Address - Country:US
Mailing Address - Phone:580-338-2070
Mailing Address - Fax:
Practice Address - Street 1:517 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4433
Practice Address - Country:US
Practice Address - Phone:580-338-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
OK3456302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK327625945001OtherBCBS
OK243406601Medicare PIN