Provider Demographics
NPI:1669626768
Name:JOHNSON, BRIAN SAMUEL (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SAMUEL
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 1:200 N LA CUMBRE RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-2588
Mailing Address - Country:US
Mailing Address - Phone:805-308-4596
Mailing Address - Fax:
Practice Address - Street 1:200 N LA CUMBRE RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-2588
Practice Address - Country:US
Practice Address - Phone:805-308-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor