Provider Demographics
NPI:1568511863
Name:JOHNSON, LAWRENCE A (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
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 1:90 JERICHO TPKE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1845
Mailing Address - Country:US
Mailing Address - Phone:516-248-4960
Mailing Address - Fax:516-248-4962
Practice Address - Street 1:90 JERICHO TPKE
Practice Address - Street 2:SUITE 6
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1845
Practice Address - Country:US
Practice Address - Phone:516-248-4960
Practice Address - Fax:516-248-4962
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2293111NS0005X
FL3198111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX13601Medicare PIN