Provider Demographics
NPI:1265473797
Name:JOHNSTON, LINDA M (DC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-3328
Mailing Address - Country:US
Mailing Address - Phone:785-632-2053
Mailing Address - Fax:785-632-2083
Practice Address - Street 1:115 6TH ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-3328
Practice Address - Country:US
Practice Address - Phone:785-632-2053
Practice Address - Fax:785-632-2083
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060973Medicare ID - Type Unspecified
KSU73583Medicare UPIN