Provider Demographics
NPI:1659519197
Name:JOHNSON, JULIA CRYSTAL (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:CRYSTAL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E SAN MIGUEL ST APT 4
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3662
Mailing Address - Country:US
Mailing Address - Phone:562-665-2605
Mailing Address - Fax:
Practice Address - Street 1:1301 E SAN MIGUEL ST APT 4
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3662
Practice Address - Country:US
Practice Address - Phone:562-665-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6270111N00000X
CADC 30892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor