Provider Demographics
NPI:1831467745
Name:JOHNSON, JOSEPH JUNIOR (ND)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JUNIOR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 NOB HILL CIR
Mailing Address - Street 2:UNIT B
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1827
Mailing Address - Country:US
Mailing Address - Phone:203-345-9335
Mailing Address - Fax:
Practice Address - Street 1:18 REEF RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5920
Practice Address - Country:US
Practice Address - Phone:203-345-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000471175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath