Provider Demographics
NPI:1891792131
Name:JOHNSON, ROBERT TOVEY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TOVEY
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 1:1041 CHETCO AVE # 141
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-7153
Mailing Address - Country:US
Mailing Address - Phone:541-708-2060
Mailing Address - Fax:541-982-7019
Practice Address - Street 1:603 HEMLOCK ST STE 3B
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9425
Practice Address - Country:US
Practice Address - Phone:541-708-2060
Practice Address - Fax:541-982-7019
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-26289111N00000X
OR3498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
611981700OtherDEPT OF LABOR FECA #
CA4586534Medicaid
CA68-0474669OtherIRS EIN
CA68-0474669OtherIRS EIN
CA4586534Medicaid