Provider Demographics
NPI:1912042250
Name:JOHNSON, ERIC U (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:U
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 1:226 VENICE WAY
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4648
Mailing Address - Country:US
Mailing Address - Phone:304-876-0500
Mailing Address - Fax:
Practice Address - Street 1:1185 MOUNT AETNA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6832
Practice Address - Country:US
Practice Address - Phone:301-739-0790
Practice Address - Fax:301-739-0353
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR155OtherBLUECHOICE FEP
WV1017515OtherBRICKSTREET
MD609578OtherACN
MD095990OtherAETNA
MD41578OtherIWIF
MDEJ1004587OtherASHN
MD220619OtherMAMSI MDIPA OPT CHC ALLIA
MD095990OtherAETNA
MDR155OtherBLUECHOICE FEP