Provider Demographics
NPI:1477994424
Name:JOHNSON, CHADWYCK (LAC, LMBT)
Entity Type:Individual
Prefix:
First Name:CHADWYCK
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LAC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GREELEY ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3207
Mailing Address - Country:US
Mailing Address - Phone:828-333-5087
Mailing Address - Fax:
Practice Address - Street 1:485 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2765
Practice Address - Country:US
Practice Address - Phone:828-333-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-07
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist