Provider Demographics
NPI:1326221102
Name:JOHNSTON CHIROPRACTIC D.C.,P.C.
Entity Type:Organization
Organization Name:JOHNSTON CHIROPRACTIC D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-772-5042
Mailing Address - Street 1:2255 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3195
Mailing Address - Country:US
Mailing Address - Phone:303-772-5042
Mailing Address - Fax:303-776-2912
Practice Address - Street 1:2255 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3195
Practice Address - Country:US
Practice Address - Phone:303-772-5042
Practice Address - Fax:303-776-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC532648Medicare UPIN
COC533148Medicare UPIN