Provider Demographics
NPI:1922321710
Name:JOHNSON, CHAD THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:THOMAS
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 1:15 E CENTRAL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1109
Mailing Address - Country:US
Mailing Address - Phone:509-464-0444
Mailing Address - Fax:509-464-0449
Practice Address - Street 1:15 E CENTRAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1109
Practice Address - Country:US
Practice Address - Phone:509-464-0444
Practice Address - Fax:509-464-0449
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60130026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor