Provider Demographics
NPI:1629461025
Name:JOHNSON, HARVEY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:JAMES
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 922
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-0922
Mailing Address - Country:US
Mailing Address - Phone:505-565-0548
Mailing Address - Fax:
Practice Address - Street 1:4205 HWY 314 SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9768
Practice Address - Country:US
Practice Address - Phone:505-565-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor