Provider Demographics
NPI:1407940927
Name:JOHNSON, ROBERT REED (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:REED
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 1:5695 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7017
Mailing Address - Country:US
Mailing Address - Phone:901-767-6727
Mailing Address - Fax:901-767-5460
Practice Address - Street 1:5695 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-7017
Practice Address - Country:US
Practice Address - Phone:901-767-6727
Practice Address - Fax:901-767-5460
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU64065Medicare UPIN
TN3678667Medicare ID - Type Unspecified