Provider Demographics
NPI:1831137157
Name:JOHNSON, JOHN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
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 1:105 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-2821
Mailing Address - Country:US
Mailing Address - Phone:337-238-0027
Mailing Address - Fax:337-238-0227
Practice Address - Street 1:105 WARNER ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-2821
Practice Address - Country:US
Practice Address - Phone:337-238-0027
Practice Address - Fax:337-238-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X956Medicare PIN
LAU76323Medicare UPIN