Provider Demographics
NPI:1912995234
Name:JOHNSON, ARTHUR JOHN (DC)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:JOHN
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 1:460 N GRANDSTAFF DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-1659
Mailing Address - Country:US
Mailing Address - Phone:260-925-6686
Mailing Address - Fax:260-925-6689
Practice Address - Street 1:460 N GRANDSTAFF DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1659
Practice Address - Country:US
Practice Address - Phone:260-925-6686
Practice Address - Fax:260-925-6689
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ08001659111N00000X
IN81000044A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091343OtherANTHEM/BC BS
IN5680124OtherAETNA
IN5680124OtherAETNA
IN350037445Medicare ID - Type UnspecifiedRAILROAD MC
INU60186Medicare UPIN