Provider Demographics
NPI:1194867200
Name:JOHNSON, KEVIN STUART (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:STUART
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 1:229 N EGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1741
Mailing Address - Country:US
Mailing Address - Phone:541-573-7733
Mailing Address - Fax:541-573-7732
Practice Address - Street 1:229 N EGAN AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1741
Practice Address - Country:US
Practice Address - Phone:541-573-7733
Practice Address - Fax:541-573-7732
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor