Provider Demographics
NPI:1659311256
Name:JOHNSON, ROBERT ELWOOD I (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELWOOD
Last Name:JOHNSON
Suffix:I
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 1:175 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1623
Mailing Address - Country:US
Mailing Address - Phone:215-321-3100
Mailing Address - Fax:215-321-7394
Practice Address - Street 1:175 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1623
Practice Address - Country:US
Practice Address - Phone:215-321-3100
Practice Address - Fax:215-321-7394
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004013L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor