Provider Demographics
NPI:1407872427
Name:JOHNSON, JAMES D (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
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 1:704 S TIMBERLANE DR
Mailing Address - Street 2:STE.13
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6929
Mailing Address - Country:US
Mailing Address - Phone:870-875-2225
Mailing Address - Fax:
Practice Address - Street 1:704 S TIMBERLANE DR
Practice Address - Street 2:STE.13
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6929
Practice Address - Country:US
Practice Address - Phone:870-875-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5U068Medicare ID - Type Unspecified
710814989Medicare UPIN