Provider Demographics
NPI:1609811652
Name:JOHNSON, RICHARD F (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
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 1:12 OPPORTUNITY DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-9185
Mailing Address - Country:US
Mailing Address - Phone:870-942-8014
Mailing Address - Fax:870-942-8014
Practice Address - Street 1:12 OPPORTUNITY DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-9185
Practice Address - Country:US
Practice Address - Phone:870-942-8014
Practice Address - Fax:870-942-8014
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59723Medicare ID - Type Unspecified