Provider Demographics
NPI:1285039321
Name:JOHNSON, TANNER COLBY (DC)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:COLBY
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 1:1919 65TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7965
Mailing Address - Country:US
Mailing Address - Phone:970-353-5300
Mailing Address - Fax:
Practice Address - Street 1:1919 65TH AVE UNIT A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7965
Practice Address - Country:US
Practice Address - Phone:970-353-5300
Practice Address - Fax:970-353-5332
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor