MEDICARE: GREGORY EUGENE JOHNSON

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

General Provider Information

NPI Number	:	1700147949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY EUGENE JOHNSON

Provider Business Mailing Address
First Line	:	363 N SAM HOUSTON PKWY E
Second Line	:	STE 1100
City	:	HOUSTON
State	:	TX
Zip	:	77060-2404
Country	:	US
Telephone Number	:	281-405-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 N SAM HOUSTON PKWY E
Second Line	:	STE 1100
City	:	HOUSTON
State	:	TX
Zip	:	77060-2404
Country	:	US
Telephone Number	:	281-405-2611
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY E JOHNSON
Credential	:	DC
Telephone Number	:	281-405-2611

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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