Provider Demographics
NPI:1417004615
Name:JOHNSON, DAVID C (DC, MUAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC, MUAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W UNION HILLS DR STE 7
Mailing Address - Street 2:309
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1656
Mailing Address - Country:US
Mailing Address - Phone:602-765-9736
Mailing Address - Fax:602-942-2106
Practice Address - Street 1:5930 W GREENWAY RD STE 26
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3291
Practice Address - Country:US
Practice Address - Phone:602-765-9736
Practice Address - Fax:602-942-2106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0242661OtherAZ BLUE CROSS BLUE SHIELD
AZU64194Medicare UPIN
AZDC5344Medicare PIN