Provider Demographics
NPI:1700061967
Name:JOHNSON, KODY R (DC)
Entity Type:Individual
Prefix:DR
First Name:KODY
Middle Name:R
Last Name:JOHNSON
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 1:1301 ASHLAND RD
Mailing Address - Street 2:APT. F
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5387
Mailing Address - Country:US
Mailing Address - Phone:660-651-4335
Mailing Address - Fax:
Practice Address - Street 1:2011 CHAPEL PLAZA CT
Practice Address - Street 2:SUITE 111
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6398
Practice Address - Country:US
Practice Address - Phone:660-651-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007034175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor