Provider Demographics
NPI:1356402804
Name:ROBINSON, JOHNNY E (DC)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:E
Last Name:ROBINSON
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:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-1000
Mailing Address - Country:US
Mailing Address - Phone:248-443-5545
Mailing Address - Fax:248-443-5560
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE 260
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-443-5545
Practice Address - Fax:248-443-5560
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4379382Medicaid
MI950F355270OtherBCBSM
MI0P08050Medicare ID - Type UnspecifiedCHIROPRACTIC