Provider Demographics
NPI:1831238245
Name:JOHNSTON CHIROPRACTIC CENTER, INC P.S.
Entity type:Organization
Organization Name:JOHNSTON CHIROPRACTIC CENTER, INC P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-662-9571
Mailing Address - Street 1:501 IDAHO STREET
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2841
Mailing Address - Country:US
Mailing Address - Phone:509-662-9571
Mailing Address - Fax:509-662-6982
Practice Address - Street 1:501 IDAHO STREET
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2841
Practice Address - Country:US
Practice Address - Phone:509-662-9571
Practice Address - Fax:509-662-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600405811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0040390OtherWA DEPT OF LABOR & INDUST
WA2459907Medicaid
WA469282OtherRR MEDICARE
WA2459907Medicaid
WA1G1AB01682Medicare ID - Type Unspecified