Provider Demographics
NPI:1750026613
Name:JOHNSON, MIKAYLA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:MIKAYLA
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:SUE
Other - Last Name:MEDBERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3230 S EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-7818
Mailing Address - Country:US
Mailing Address - Phone:903-465-1881
Mailing Address - Fax:903-463-4070
Practice Address - Street 1:2021 N HERITAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-892-3471
Practice Address - Fax:903-893-2745
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor