Provider Demographics
NPI:1871691071
Name:JOHNSTON, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:JOHNSTON
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 1:1405 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4058
Mailing Address - Country:US
Mailing Address - Phone:352-373-5510
Mailing Address - Fax:352-373-7052
Practice Address - Street 1:1405 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4058
Practice Address - Country:US
Practice Address - Phone:352-373-5510
Practice Address - Fax:352-373-7052
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88906OtherBLUE CROSS BLUE SHIELD
FLP00240797OtherRAILRAOD MEDICARE
FLT85916Medicare UPIN
FL88906AMedicare ID - Type Unspecified