Provider Demographics
NPI:1265431365
Name:JOHNSON, BRITT ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRITT
Middle Name:ALAN
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 1:563 BROADWAY
Mailing Address - Street 2:B3, B4
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3749
Mailing Address - Country:US
Mailing Address - Phone:617-389-0013
Mailing Address - Fax:617-389-0024
Practice Address - Street 1:563 BROADWAY
Practice Address - Street 2:B3, B4
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3749
Practice Address - Country:US
Practice Address - Phone:617-389-0013
Practice Address - Fax:617-389-0024
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA692111N00000X
NYX003141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y35486OtherBCBS
MAJO Y35486Medicare ID - Type Unspecified