Provider Demographics
NPI:1881076222
Name:JOHNSON CHIROPRACTIC & HOLISTIC HEALTH CENTER, LLC
Entity type:Organization
Organization Name:JOHNSON CHIROPRACTIC & HOLISTIC HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KODY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-447-0841
Mailing Address - Street 1:1109 CLUB VILLAGE DR
Mailing Address - Street 2:SUITE #104
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4466
Mailing Address - Country:US
Mailing Address - Phone:573-447-0841
Mailing Address - Fax:
Practice Address - Street 1:1109 CLUB VILLAGE DR
Practice Address - Street 2:SUITE #104
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4466
Practice Address - Country:US
Practice Address - Phone:573-447-0841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007034175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty