Healthcare Provider Details

I. General information

NPI: 1174523955
Provider Name (Legal Business Name): ALAN LEE JOHNSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S MYRTLE AVE
CLEARWATER FL
33756-5617
US

IV. Provider business mailing address

703 S MYRTLE AVE
CLEARWATER FL
33756-5617
US

V. Phone/Fax

Practice location:
  • Phone: 727-446-2208
  • Fax: 727-443-0750
Mailing address:
  • Phone: 727-446-2208
  • Fax: 727-443-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH4945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: