Provider Demographics
NPI:1275689465
Name:JOHNSTON, DALE BURT (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:BURT
Last Name:JOHNSTON
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:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-0691
Mailing Address - Country:US
Mailing Address - Phone:503-682-9046
Mailing Address - Fax:503-682-9046
Practice Address - Street 1:30045 SW PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9735
Practice Address - Country:US
Practice Address - Phone:503-682-9046
Practice Address - Fax:503-682-9046
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1544111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician