Provider Demographics
NPI:1467512301
Name:JOHNSON, SHARON ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E COLLEGE WAY
Mailing Address - Street 2:STE. A-558
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5637
Mailing Address - Country:US
Mailing Address - Phone:360-770-2392
Mailing Address - Fax:
Practice Address - Street 1:1008 DIGBY LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9140
Practice Address - Country:US
Practice Address - Phone:360-770-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA33858OtherLABOR & INDUSTRIES