Provider Demographics
NPI:1720184070
Name:JOHNSON, LU ELAINE (DR OF CHIROPRACTIC)
Entity Type:Individual
Prefix:
First Name:LU ELAINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DR OF CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2732
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037
Mailing Address - Country:US
Mailing Address - Phone:305-453-3337
Mailing Address - Fax:305-453-3337
Practice Address - Street 1:100460 OVERSEAS HWY STE 4
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2547
Practice Address - Country:US
Practice Address - Phone:305-453-3337
Practice Address - Fax:305-453-8485
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8222111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266776200Medicaid
FLA3962Medicare UPIN
FL266776200Medicaid