Provider Demographics
NPI:1013090661
Name:JOHNSON, MARCUS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:WAYNE
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 1:5101 WASHINGTON ST STE 13
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2988
Mailing Address - Country:US
Mailing Address - Phone:847-672-7920
Mailing Address - Fax:847-672-7916
Practice Address - Street 1:1780 GREEN BAY RD.
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-432-4077
Practice Address - Fax:847-681-8940
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor