Provider Demographics
NPI:1790728897
Name:JOHNSTON, MADELINE CLAIRE (DC)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:CLAIRE
Last Name:JOHNSTON
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 1:4540 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4515
Mailing Address - Country:US
Mailing Address - Phone:972-789-9333
Mailing Address - Fax:972-789-9557
Practice Address - Street 1:4540 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4515
Practice Address - Country:US
Practice Address - Phone:972-789-9333
Practice Address - Fax:972-789-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U7030OtherBLUECROSS INDIVIDUAL #
TX606069OtherBC/BS YEARS 2000-2005
TX8594OtherCHIROPRACTIC LICENSE
TX0097NCOtherBLUE CROSS GROUP NUMBER
TX606069OtherBC/BS YEARS 2000-2005
TX84-1699328OtherEIN STARTING IN 2006