Provider Demographics
NPI:1669696621
Name:JOHNSON CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:JOHNSON CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-464-0444
Mailing Address - Street 1:5251 R ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-3422
Mailing Address - Country:US
Mailing Address - Phone:402-464-0444
Mailing Address - Fax:402-464-3699
Practice Address - Street 1:5251 R ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-3422
Practice Address - Country:US
Practice Address - Phone:402-464-0444
Practice Address - Fax:402-464-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099808Medicare ID - Type Unspecified