Provider Demographics
NPI:1619062502
Name:JOHNSON, JEFF K (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:K
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 1:5251 R ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3422
Mailing Address - Country:US
Mailing Address - Phone:402-464-0444
Mailing Address - Fax:402-464-3699
Practice Address - Street 1:5251 R ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3422
Practice Address - Country:US
Practice Address - Phone:402-464-0444
Practice Address - Fax:402-464-3699
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081678500Medicaid
NE47081678500Medicaid
NET93038Medicare UPIN