Provider Demographics
NPI:1568502144
Name:JOHNSON, CHRIS A (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:JOHNSON
Other - Last Name:CARLOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1024 PICO BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1471
Mailing Address - Country:US
Mailing Address - Phone:310-399-0460
Mailing Address - Fax:
Practice Address - Street 1:1009 WILSHIRE BLVD STE 221
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1931
Practice Address - Country:US
Practice Address - Phone:310-393-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23285111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician