Provider Demographics
NPI:1841527033
Name:JOHNSON, CLARK MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:MICHAEL
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 1:1221 ALHAMBRA BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5237
Mailing Address - Country:US
Mailing Address - Phone:916-451-5552
Mailing Address - Fax:916-451-0756
Practice Address - Street 1:1221 ALHAMBRA BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5237
Practice Address - Country:US
Practice Address - Phone:916-451-5552
Practice Address - Fax:916-451-0756
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor