Healthcare Provider Details

I. General information

NPI: 1881972834
Provider Name (Legal Business Name): TYRONE D JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 AUSTIN BLUFFS PKWY SUITE 110
COLORADO SPRINGS CO
80918-5723
US

IV. Provider business mailing address

3425 AUSTIN BLUFFS PKWY SUITE 110
COLORADO SPRINGS CO
80918-5723
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-0254
  • Fax:
Mailing address:
  • Phone: 719-630-0254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4597
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: