Provider Demographics
NPI:1790708949
Name:JOHNSON, VALERIE (DC)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 WISHIRE BLVD, BLDG 500
Mailing Address - Street 2:MAILCODE: 117
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4781
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:BUILDING 500, MAILCODE 117
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4935
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor