Provider Demographics
NPI:1346312469
Name:GORDON C. JOHNSON
Entity Type:Organization
Organization Name:GORDON C. JOHNSON
Other - Org Name:MURFREESBORO CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-849-9064
Mailing Address - Street 1:1535 W NORTHFIELD BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1427
Mailing Address - Country:US
Mailing Address - Phone:615-849-9064
Mailing Address - Fax:615-849-7744
Practice Address - Street 1:1535 W NORTHFIELD BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1427
Practice Address - Country:US
Practice Address - Phone:615-849-9064
Practice Address - Fax:615-849-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3677190Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER