Provider Demographics
NPI:1417990896
Name:JOHNSTONE, CARLTON DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:DOUGLAS
Last Name:JOHNSTONE
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 1:49 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843
Mailing Address - Country:US
Mailing Address - Phone:207-236-3416
Mailing Address - Fax:207-236-8188
Practice Address - Street 1:49 ELM ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843
Practice Address - Country:US
Practice Address - Phone:207-236-3416
Practice Address - Fax:207-236-8188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR593111N00000X
VT708111N00000X
CT000389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048061OtherANTHEM
MEJ0015277Medicare ID - Type Unspecified
ME048061OtherANTHEM