Provider Demographics
NPI:1629084629
Name:JOHNSON, CRAIG M (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
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 1:1107 E CHAPMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2129
Mailing Address - Country:US
Mailing Address - Phone:714-633-1913
Mailing Address - Fax:714-633-1932
Practice Address - Street 1:1107 E CHAPMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2129
Practice Address - Country:US
Practice Address - Phone:714-633-1913
Practice Address - Fax:714-633-1932
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC13559Medicare ID - Type Unspecified