Provider Demographics
NPI:1710286786
Name:JOHNSON, BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
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 1:917 8TH AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4768
Mailing Address - Country:US
Mailing Address - Phone:615-620-0904
Mailing Address - Fax:615-815-3141
Practice Address - Street 1:917 8TH AVE S STE C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4768
Practice Address - Country:US
Practice Address - Phone:615-620-0904
Practice Address - Fax:615-815-3141
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002515111N00000X
MO2011024097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor