Provider Demographics
NPI:1508800780
Name:JOHNSON, RICHARD BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRIAN
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 1:5755 W MAPLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4415
Mailing Address - Country:US
Mailing Address - Phone:248-626-3030
Mailing Address - Fax:248-626-3455
Practice Address - Street 1:5755 W MAPLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4415
Practice Address - Country:US
Practice Address - Phone:248-626-3030
Practice Address - Fax:248-626-3455
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI116940OtherSLECTCARE INSURANCE ID
MI142932577Medicaid
MI950F32961OtherBLUE CROSS BLUE SHIELD
MI116940OtherSLECTCARE INSURANCE ID
MI142932577Medicaid