Provider Demographics
NPI:1912233271
Name:JOHNSTON, JAMEY L (CAC)
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 E CAPITOL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2119
Mailing Address - Country:US
Mailing Address - Phone:414-460-6492
Mailing Address - Fax:
Practice Address - Street 1:2321 E CAPITOL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2119
Practice Address - Country:US
Practice Address - Phone:414-460-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI463-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist