Provider Demographics
NPI:1992197180
Name:JOHNSON, BROCK (DC)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:
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 1:1583 MAIN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5214
Mailing Address - Country:US
Mailing Address - Phone:479-443-0800
Mailing Address - Fax:479-443-5535
Practice Address - Street 1:2630 E CITIZENS DR STE 6
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4797
Practice Address - Country:US
Practice Address - Phone:479-935-3021
Practice Address - Fax:479-777-9921
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor