Provider Demographics
NPI:1336366228
Name:JOHNSON, TAWANA (DC)
Entity Type:Individual
Prefix:DR
First Name:TAWANA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
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:PO BOX 1915
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27402-1915
Mailing Address - Country:US
Mailing Address - Phone:336-272-1339
Mailing Address - Fax:336-510-8605
Practice Address - Street 1:1400 BATTLEGROUND AVE
Practice Address - Street 2:SUITE 150A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8042
Practice Address - Country:US
Practice Address - Phone:336-272-1339
Practice Address - Fax:336-510-8605
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3061111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085JYMedicaid
NCU92159Medicare UPIN
NC89085JYMedicaid