Provider Demographics
NPI:1346382744
Name:JOHNSON, RESA F (DC, DACBN)
Entity Type:Individual
Prefix:
First Name:RESA
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 E CHESTNUT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2350
Mailing Address - Country:US
Mailing Address - Phone:828-255-0007
Mailing Address - Fax:828-255-0500
Practice Address - Street 1:192 E CHESTNUT ST
Practice Address - Street 2:SUITE D
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2350
Practice Address - Country:US
Practice Address - Phone:828-255-0007
Practice Address - Fax:828-255-0500
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC839111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454268Medicare PIN
NC2454696Medicare ID - Type Unspecified