Provider Demographics
NPI:1740258631
Name:JOHNSON, THOMAS NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NEIL
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 1:7131 NE FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-5835
Mailing Address - Country:US
Mailing Address - Phone:503-284-6727
Mailing Address - Fax:503-265-2300
Practice Address - Street 1:7131 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-5835
Practice Address - Country:US
Practice Address - Phone:503-284-6727
Practice Address - Fax:503-265-2300
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGDTMMedicare ID - Type Unspecified