Provider Demographics
NPI:1275695439
Name:DLJOHNSON, INC PS
Entity Type:Organization
Organization Name:DLJOHNSON, INC PS
Other - Org Name:NORTH TAPPS FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-862-7196
Mailing Address - Street 1:314 182ND AVE E
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-5704
Mailing Address - Country:US
Mailing Address - Phone:253-862-7196
Mailing Address - Fax:253-862-7290
Practice Address - Street 1:314 182ND AVE E
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE TAPPS
Practice Address - State:WA
Practice Address - Zip Code:98391-5704
Practice Address - Country:US
Practice Address - Phone:253-862-7196
Practice Address - Fax:253-862-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA157839OtherWORKMANS COMP