Provider Demographics
NPI:1467626853
Name:JOHNSON, PATRICK DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DEAN
Last Name:JOHNSON
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 1:1010 DELTA AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837
Mailing Address - Country:US
Mailing Address - Phone:906-428-9076
Mailing Address - Fax:906-368-4343
Practice Address - Street 1:1010 DELTA AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837
Practice Address - Country:US
Practice Address - Phone:906-428-9076
Practice Address - Fax:906-368-4343
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009453111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor