Provider Demographics
NPI:1669539565
Name:JOHNSTON, DAVID R (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:JOHNSTON
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 1:6325 195TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5143
Mailing Address - Country:US
Mailing Address - Phone:425-774-6876
Mailing Address - Fax:425-775-2739
Practice Address - Street 1:6325 195TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5143
Practice Address - Country:US
Practice Address - Phone:425-774-6876
Practice Address - Fax:425-775-2739
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA37464OtherL&I NUMBER
WAJO1054OtherREGENCE RIDER #
WACH00002931OtherCHIROPRACTIC LICENSE #
WA37464OtherL&I NUMBER