Provider Demographics
NPI:1538504188
Name:JOHNSON, NAKOMA ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:NAKOMA
Middle Name:ROSE
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 1:7730 WOLF RIVER BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1737
Mailing Address - Country:US
Mailing Address - Phone:901-756-2424
Mailing Address - Fax:901-756-7504
Practice Address - Street 1:7730 WOLF RIVER BLVD STE 112
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1737
Practice Address - Country:US
Practice Address - Phone:901-756-2424
Practice Address - Fax:901-756-7504
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor