Provider Demographics
NPI:1710687116
Name:JOHNSON, DANITA J
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S MICHIGAN AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2860
Mailing Address - Country:US
Mailing Address - Phone:312-375-5556
Mailing Address - Fax:312-528-0448
Practice Address - Street 1:2600 S MICHIGAN AVE STE 314
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2860
Practice Address - Country:US
Practice Address - Phone:312-375-5556
Practice Address - Fax:312-528-0448
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath