Provider Demographics
NPI:1619255940
Name:JOHNSON, GERTRUDE ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:GERTRUDE
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
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:PO BOX 91474
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-1474
Mailing Address - Country:US
Mailing Address - Phone:323-359-4729
Mailing Address - Fax:562-494-7141
Practice Address - Street 1:7313 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1621
Practice Address - Country:US
Practice Address - Phone:323-359-4729
Practice Address - Fax:562-474-7141
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor