Provider Demographics
NPI:1710602537
Name:MARK JOHNSON CHIROPRACTIC P.S.C.
Entity Type:Organization
Organization Name:MARK JOHNSON CHIROPRACTIC P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-431-4430
Mailing Address - Street 1:3955 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-2027
Mailing Address - Country:US
Mailing Address - Phone:859-431-4430
Mailing Address - Fax:859-431-9560
Practice Address - Street 1:3955 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-2027
Practice Address - Country:US
Practice Address - Phone:859-431-4430
Practice Address - Fax:859-431-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty