Provider Demographics
NPI:1952466898
Name:JOHNSON, COLLIN D (DC)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:D
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:QUEEN ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21657-0205
Mailing Address - Country:US
Mailing Address - Phone:410-490-7401
Mailing Address - Fax:410-758-4910
Practice Address - Street 1:32201 QUEEN ANNE HWY
Practice Address - Street 2:
Practice Address - City:QUEEN ANNE
Practice Address - State:MD
Practice Address - Zip Code:21657-0205
Practice Address - Country:US
Practice Address - Phone:410-364-9222
Practice Address - Fax:410-364-9310
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD76-0815371OtherSOLE PROPRIETOR EIN