Provider Demographics
NPI:1689731564
Name:JOHNSON, ROBERTA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:MICHELLE
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 1:6059 S QUEBEC ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4514
Mailing Address - Country:US
Mailing Address - Phone:303-741-1181
Mailing Address - Fax:303-741-1191
Practice Address - Street 1:6059 S QUEBEC ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4514
Practice Address - Country:US
Practice Address - Phone:303-741-1181
Practice Address - Fax:303-741-1191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor