Provider Demographics
NPI:1336217280
Name:JOHNS, KEITH D (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:D
Last Name:JOHNS
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:J2272 SE ONE ROSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMUS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-888-1028
Mailing Address - Fax:503-659-7471
Practice Address - Street 1:3716 SE INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:503-659-0073
Practice Address - Fax:503-659-7471
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA30176OtherDEPT OF LABOR & INDIS
370939OtherAMERICAN SPECIALITY PB
370939OtherAMERICAN SPECIALITY PB