Provider Demographics
NPI:1154649648
Name:JOHNSON, JAMES MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
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 1:4716 4TH ST. STE. 102
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416
Mailing Address - Country:US
Mailing Address - Phone:806-224-0063
Mailing Address - Fax:
Practice Address - Street 1:4716 4TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4953
Practice Address - Country:US
Practice Address - Phone:806-224-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor