Provider Demographics
NPI:1558446930
Name:JOHNSON, BRAD ANOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ANOTHY
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 1:310 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3914
Mailing Address - Country:US
Mailing Address - Phone:740-353-8888
Mailing Address - Fax:740-353-8889
Practice Address - Street 1:310 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4915
Practice Address - Country:US
Practice Address - Phone:740-353-8888
Practice Address - Fax:740-353-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0986358Medicaid
OHU51688Medicare UPIN
OH0986358Medicaid