Provider Demographics
NPI:1659406858
Name:JOHNSON, KARSON B (DC)
Entity Type:Individual
Prefix:DR
First Name:KARSON
Middle Name:B
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 1:1472 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2224
Mailing Address - Country:US
Mailing Address - Phone:435-750-6236
Mailing Address - Fax:435-750-6290
Practice Address - Street 1:1472 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2224
Practice Address - Country:US
Practice Address - Phone:435-750-6236
Practice Address - Fax:435-750-6290
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290547-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU44683Medicare UPIN