Provider Demographics
NPI:1619221082
Name:JOHNSON CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC CENTER, PC
Other - Org Name:NORTH EAST TEXAS CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-905-4939
Mailing Address - Street 1:201 N. COLLEGIATE
Mailing Address - Street 2:#900
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460
Mailing Address - Country:US
Mailing Address - Phone:903-905-4939
Mailing Address - Fax:903-905-4940
Practice Address - Street 1:201 N. COLLEGIATE
Practice Address - Street 2:#900
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-905-4939
Practice Address - Fax:903-905-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty