Provider Demographics
NPI:1821131715
Name:JOHNSON, BRETT LAMBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:LAMBERT
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 1:591 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-2433
Mailing Address - Country:US
Mailing Address - Phone:570-323-0583
Mailing Address - Fax:
Practice Address - Street 1:800 W 4TH ST
Practice Address - Street 2:SUITE G-02
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5895
Practice Address - Country:US
Practice Address - Phone:570-323-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098250Medicare ID - Type UnspecifiedCHIROPRACTOR