Provider Demographics
NPI:1376557744
Name:JOHNSON, MICHAEL AARON (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AARON
Last Name:JOHNSON
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 1:451 WESTPARK WAY
Mailing Address - Street 2:STE 7
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3703
Mailing Address - Country:US
Mailing Address - Phone:817-354-7300
Mailing Address - Fax:817-799-0866
Practice Address - Street 1:451 WESTPARK WAY
Practice Address - Street 2:STE 7
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3703
Practice Address - Country:US
Practice Address - Phone:817-354-7300
Practice Address - Fax:817-799-0866
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606397OtherBCBS
TX606397OtherBCBS
U67564Medicare UPIN