Provider Demographics
NPI:1275724569
Name:JOHNSON CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-592-1459
Mailing Address - Street 1:5400 UNIVERSITY BLVD
Mailing Address - Street 2:SPUR 248
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 UNIVERSITY BLVD
Practice Address - Street 2:103
Practice Address - City:TYLER
Practice Address - State:TN
Practice Address - Zip Code:75707
Practice Address - Country:US
Practice Address - Phone:903-592-1459
Practice Address - Fax:903-531-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty