Provider Demographics
NPI:1801975693
Name:JOHNSON, ROBERT M (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 S VENTURA RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6506
Mailing Address - Country:US
Mailing Address - Phone:805-985-8507
Mailing Address - Fax:805-985-7647
Practice Address - Street 1:653 S VENTURA RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6506
Practice Address - Country:US
Practice Address - Phone:805-985-8507
Practice Address - Fax:805-985-7647
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20462Medicare ID - Type Unspecified