Provider Demographics
NPI:1497943153
Name:JOHNSTONE, JERRY STANLEY II (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:STANLEY
Last Name:JOHNSTONE
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JEREMY
Other - Middle Name:STANLEY
Other - Last Name:JOHNSTONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:515 SR 9 NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8523
Mailing Address - Country:US
Mailing Address - Phone:425-334-1874
Mailing Address - Fax:425-334-3852
Practice Address - Street 1:515 SR 9 NE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8523
Practice Address - Country:US
Practice Address - Phone:425-334-1874
Practice Address - Fax:425-334-3852
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36298Medicare PIN