Provider Demographics
NPI:1184651341
Name:JOHNSON, WILLIAM R (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
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 1:221 SO MIDDLETOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954
Mailing Address - Country:US
Mailing Address - Phone:845-623-0026
Mailing Address - Fax:845-623-0096
Practice Address - Street 1:221 SO MIDDLETOWN ROAD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:845-623-0026
Practice Address - Fax:845-623-0096
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1011481OtherOXFORD
P1011481OtherOXFORD
X8A941Medicare ID - Type Unspecified