Provider Demographics
NPI:1205870615
Name:JOHNSON, DAVID W
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 996
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-0996
Mailing Address - Country:US
Mailing Address - Phone:319-366-2225
Mailing Address - Fax:319-366-1726
Practice Address - Street 1:515 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2132
Practice Address - Country:US
Practice Address - Phone:319-366-2225
Practice Address - Fax:319-366-1726
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0147306Medicaid
IA0147306Medicaid
IAT00893Medicare UPIN