Provider Demographics
NPI:1851510200
Name:JOHNSON, MARCUS LORENZO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:LORENZO
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 1:1220 INDIAN RUN DR APT 1118
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-2107
Mailing Address - Country:US
Mailing Address - Phone:214-731-8187
Mailing Address - Fax:
Practice Address - Street 1:13021 COIT RD STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5700
Practice Address - Country:US
Practice Address - Phone:972-726-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor