Provider Demographics
NPI:1881972834
Name:JOHNSON, TYRONE D (DC)
Entity type:Individual
Prefix:
First Name:TYRONE
Middle Name:D
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 1:3425 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5723
Mailing Address - Country:US
Mailing Address - Phone:719-630-0254
Mailing Address - Fax:
Practice Address - Street 1:3425 AUSTIN BLUFFS PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5723
Practice Address - Country:US
Practice Address - Phone:719-630-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor