Provider Demographics
NPI:1417120957
Name:JOHNSTONE CHIROPRACTIC INC PS
Entity Type:Organization
Organization Name:JOHNSTONE CHIROPRACTIC INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:425-334-1874
Mailing Address - Street 1:515 STATE ROUTE 9 NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8523
Mailing Address - Country:US
Mailing Address - Phone:425-334-1874
Mailing Address - Fax:425-334-3852
Practice Address - Street 1:515 STATE ROUTE 9 NE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8523
Practice Address - Country:US
Practice Address - Phone:425-334-1874
Practice Address - Fax:425-334-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36298Medicare PIN