Provider Demographics
NPI:1891021143
Name:JOHNSON CHIROPRATIC LLC
Entity Type:Organization
Organization Name:JOHNSON CHIROPRATIC LLC
Other - Org Name:JOHNSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:307-684-8888
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-0423
Mailing Address - Country:US
Mailing Address - Phone:307-684-8888
Mailing Address - Fax:307-684-8882
Practice Address - Street 1:950 W FETTERMAN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-2413
Practice Address - Country:US
Practice Address - Phone:307-684-8888
Practice Address - Fax:307-684-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty