Healthcare Provider Details

I. General information

NPI: 1417285917
Provider Name (Legal Business Name): LU ELAINE JOHNSON CHIROPRACTOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99228 OVERSEAS HIGHWAY
KEY LARGO FL
33037-7732
US

IV. Provider business mailing address

99228 OVERSEAS HWY
KEY LARGO FL
33037-2468
US

V. Phone/Fax

Practice location:
  • Phone: 305-453-3337
  • Fax: 305-453-3337
Mailing address:
  • Phone: 305-453-3337
  • Fax: 305-453-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8222
License Number StateFL

VIII. Authorized Official

Name: LU ELAINE JOHNSON
Title or Position: PRESIDENT
Credential: DC
Phone: 305-453-3337