Provider Demographics
NPI:1972758548
Name:JOHNSON, SHARLENTA R (DC)
Entity Type:Individual
Prefix:DR
First Name:SHARLENTA
Middle Name:R
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 1:667 COWBOYS PKWY
Mailing Address - Street 2:#1108
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5403
Mailing Address - Country:US
Mailing Address - Phone:469-693-5895
Mailing Address - Fax:
Practice Address - Street 1:667 COWBOYS PKWY
Practice Address - Street 2:#1108
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5403
Practice Address - Country:US
Practice Address - Phone:469-693-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor