Provider Demographics
NPI:1467476507
Name:HILL, JOHNNY GENE (DC)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:GENE
Last Name:HILL
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 1:23394 JACOBSON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-4813
Mailing Address - Country:US
Mailing Address - Phone:352-686-8230
Mailing Address - Fax:352-686-8240
Practice Address - Street 1:11079 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5000
Practice Address - Country:US
Practice Address - Phone:352-686-8230
Practice Address - Fax:352-688-6240
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22020ZMedicare ID - Type Unspecified
T84272Medicare UPIN