Provider Demographics
NPI:1710174644
Name:JOHNSEY, MICHAEL KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEITH
Last Name:JOHNSEY
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 1:102 WOODVALE AVE
Mailing Address - Street 2:SUITE - C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3734
Mailing Address - Country:US
Mailing Address - Phone:337-406-4790
Mailing Address - Fax:337-406-4791
Practice Address - Street 1:102 WOODVALE AVE
Practice Address - Street 2:SUITE - C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3734
Practice Address - Country:US
Practice Address - Phone:337-406-4790
Practice Address - Fax:337-406-4791
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor