Provider Demographics
NPI:1679878128
Name:W.T. JOHNSON CHIROPRACTIC AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:W.T. JOHNSON CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-962-2221
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-1749
Mailing Address - Country:US
Mailing Address - Phone:409-962-2221
Mailing Address - Fax:409-962-6362
Practice Address - Street 1:4820 TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-3131
Practice Address - Country:US
Practice Address - Phone:409-962-2221
Practice Address - Fax:409-962-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB124601Medicare PIN