Provider Demographics
NPI:1780209379
Name:JOHNSON ACUPUNCTURE AND ORIENTAL MEDICINE, LLC
Entity Type:Organization
Organization Name:JOHNSON ACUPUNCTURE AND ORIENTAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:850-603-9466
Mailing Address - Street 1:21758 US HIGHWAY 331 N
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32567-3747
Mailing Address - Country:US
Mailing Address - Phone:850-603-9466
Mailing Address - Fax:
Practice Address - Street 1:22395 US HIGHWAY 331 N
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:FL
Practice Address - Zip Code:32567-3309
Practice Address - Country:US
Practice Address - Phone:850-834-2118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty