Provider Demographics
NPI:1780804021
Name:JOHNSON, JOE W (DC)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:W
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:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:FL
Mailing Address - Zip Code:32538-0486
Mailing Address - Country:US
Mailing Address - Phone:850-834-2118
Mailing Address - Fax:850-834-3110
Practice Address - Street 1:22395 US HIGHWAY 331 N
Practice Address - Street 2:
Practice Address - City:LAUREL HILL
Practice Address - State:FL
Practice Address - Zip Code:32567-3309
Practice Address - Country:US
Practice Address - Phone:850-834-2118
Practice Address - Fax:850-834-3110
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003289111N00000X
AL1300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1300OtherLICENSE NUMBER
FLCH0003289OtherLICENSE NUMBER
T55818Medicare UPIN
FLCH0003289OtherLICENSE NUMBER