Provider Demographics
NPI:1801905526
Name:JOHNSON, ALBERT T (DC)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:T
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 1:4600 KIETZKE LN
Mailing Address - Street 2:SUITE N258
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-5033
Mailing Address - Country:US
Mailing Address - Phone:775-826-2200
Mailing Address - Fax:775-826-2492
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:SUITE N258
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-826-2200
Practice Address - Fax:775-826-2492
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDCB417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880343027OtherEIN
NVVDCB417Medicare ID - Type UnspecifiedMEDICARE ID