Provider Demographics
NPI:1851465074
Name:JOHNSON, CRAIG BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BRIAN
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 1:1880 LANCASTER DR NE STE 127
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1069
Mailing Address - Country:US
Mailing Address - Phone:503-585-1026
Mailing Address - Fax:503-585-9604
Practice Address - Street 1:1880 LANCASTER DR NE STE 127
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1069
Practice Address - Country:US
Practice Address - Phone:503-585-1026
Practice Address - Fax:503-585-9604
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR931256123Medicare UPIN