Healthcare Provider Details

I. General information

NPI: 1063766723
Provider Name (Legal Business Name): CLYDE FRANCIS JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 S UNIVERSITY BLVD STE 100
CENTENNIAL CO
80122-5104
US

IV. Provider business mailing address

5950 S WILLOW DR STE 200
GREENWOOD VILLAGE CO
80111-5170
US

V. Phone/Fax

Practice location:
  • Phone: 303-927-6181
  • Fax:
Mailing address:
  • Phone: 720-515-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR6922
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: