Provider Demographics
NPI:1558469742
Name:JOHNSTON CHIROPRACTIC HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:JOHNSTON CHIROPRACTIC HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-373-5510
Mailing Address - Street 1:1405 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4058
Mailing Address - Country:US
Mailing Address - Phone:352-373-5510
Mailing Address - Fax:352-373-7052
Practice Address - Street 1:1405 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4058
Practice Address - Country:US
Practice Address - Phone:352-373-5510
Practice Address - Fax:352-373-7052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSTON CHIROPRACTIC HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88906OtherBLUE CROSS BLUE SHIELD
FL88906OtherBLUE CROSS BLUE SHIELD