Provider Demographics
NPI:1457783011
Name:JOHNSON, THOMAS EDWARD (DC, IDE)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC, IDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3927
Mailing Address - Country:US
Mailing Address - Phone:916-933-6700
Mailing Address - Fax:916-358-3929
Practice Address - Street 1:350 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3927
Practice Address - Country:US
Practice Address - Phone:916-933-6700
Practice Address - Fax:916-933-2253
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20642111NI0013X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner