MEDICARE: W.T. JOHNSON CHIROPRACTIC AND WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11639	TX

General Provider Information

NPI Number	:	1679878128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W.T. JOHNSON CHIROPRACTIC AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 1749
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-1749
Country	:	US
Telephone Number	:	409-962-2221
Fax Number	:	409-962-6362

Provider Business Practice Location Address
First Line	:	4820 TWIN CITY HWY
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-3131
Country	:	US
Telephone Number	:	409-962-2221
Fax Number	:	409-962-6362

Authorized Official
Title or Position	:	OWNER / PROVIDER
Name	:	DR. WILLIAM T JOHNSON
Credential	:	DC
Telephone Number	:	409-962-2221

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	06/08/2011

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