Healthcare Provider Details

I. General information

NPI: 1457783011
Provider Name (Legal Business Name): THOMAS EDWARD JOHNSON DC, IDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GREEN VALLEY RD
EL DORADO HILLS CA
95762-3927
US

IV. Provider business mailing address

350 GREEN VALLEY RD
EL DORADO HILLS CA
95762-3927
US

V. Phone/Fax

Practice location:
  • Phone: 916-933-6700
  • Fax: 916-933-2253
Mailing address:
  • Phone: 916-933-6700
  • Fax: 916-358-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number20642
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number20642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: