Provider Demographics
NPI:1922052083
Name:ERIC JOHNSON CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:ERIC JOHNSON CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-433-3475
Mailing Address - Street 1:1050 E PERRIN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5018
Mailing Address - Country:US
Mailing Address - Phone:559-433-3475
Mailing Address - Fax:559-433-3485
Practice Address - Street 1:1050 E PERRIN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-5018
Practice Address - Country:US
Practice Address - Phone:559-433-3475
Practice Address - Fax:559-433-3485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR 2853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01338ZMedicare ID - Type Unspecified