Provider Demographics
NPI:1629320973
Name:JOHNSON, KRISTIAN RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:RAYMOND
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-0039
Mailing Address - Country:US
Mailing Address - Phone:206-571-6217
Mailing Address - Fax:
Practice Address - Street 1:31030 NE 130TH ST
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-7325
Practice Address - Country:US
Practice Address - Phone:206-571-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60308074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor