Provider Demographics
NPI:1972663169
Name:JOHNSON, CYNTHIA M (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8105
Mailing Address - Country:US
Mailing Address - Phone:772-260-5555
Mailing Address - Fax:772-872-5205
Practice Address - Street 1:6140 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8105
Practice Address - Country:US
Practice Address - Phone:772-260-5555
Practice Address - Fax:772-872-5205
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70326ZMedicare PIN