Provider Demographics
NPI:1366494007
Name:JOHNS, COBY L (DC)
Entity Type:Individual
Prefix:
First Name:COBY
Middle Name:L
Last Name:JOHNS
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 1:611 S 14TH PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9256
Mailing Address - Country:US
Mailing Address - Phone:503-927-9250
Mailing Address - Fax:
Practice Address - Street 1:3300 SW HOCKEN AVE
Practice Address - Street 2:#108
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2435
Practice Address - Country:US
Practice Address - Phone:503-526-8782
Practice Address - Fax:503-526-8721
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7493111N00000X
OR71 3653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor