Provider Demographics
NPI:1831158682
Name:JOHANNES, JAMES G (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:JOHANNES
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 1:4864 BUFFALO ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2394
Mailing Address - Country:US
Mailing Address - Phone:814-899-5400
Mailing Address - Fax:814-899-6981
Practice Address - Street 1:4864 BUFFALO ROAD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2394
Practice Address - Country:US
Practice Address - Phone:814-899-5400
Practice Address - Fax:814-899-6981
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002842L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4488853OtherAETNA
PA304143OtherUPMC
PA181677OtherHIGHMARK BC/BS
1494177OtherUNITED HEALTHCARE
1494177OtherUNITED HEALTHCARE
PA181677Medicare PIN