Provider Demographics
NPI:1851311427
Name:JOHNSON, GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
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 1:5953 LAUREL CANYON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-5224
Mailing Address - Country:US
Mailing Address - Phone:818-761-7712
Mailing Address - Fax:818-506-0041
Practice Address - Street 1:5953 LAUREL CANYON BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-5224
Practice Address - Country:US
Practice Address - Phone:818-761-7712
Practice Address - Fax:818-506-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor