Provider Demographics
NPI:1811006034
Name:JOHNSON, ALBERT WILLARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:WILLARD
Last Name:JOHNSON
Suffix:
Gender:M
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:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-1228
Mailing Address - Country:US
Mailing Address - Phone:256-734-7585
Mailing Address - Fax:
Practice Address - Street 1:109 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3430
Practice Address - Country:US
Practice Address - Phone:256-734-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051519986OtherBLUE CROSS&BLUE SHIELD
AL051519986Medicare ID - Type Unspecified
ALU16644Medicare UPIN