Provider Demographics
NPI:1346328200
Name:JOHNSON, GINGER R (DC)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MASTERS PLACE DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7020
Mailing Address - Country:US
Mailing Address - Phone:501-803-4154
Mailing Address - Fax:
Practice Address - Street 1:56 MASTERS PLACE DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7020
Practice Address - Country:US
Practice Address - Phone:501-803-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59777Medicare ID - Type Unspecified