Healthcare Provider Details

I. General information

NPI: 1720184070
Provider Name (Legal Business Name): LU ELAINE JOHNSON DR. OF CHIROPRACTIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100460 OVERSEAS HWY STE 4
KEY LARGO FL
33037-2547
US

IV. Provider business mailing address

P.O. BOX 2732
KEY LARGO FL
33037
US

V. Phone/Fax

Practice location:
  • Phone: 305-453-3337
  • Fax: 305-453-8485
Mailing address:
  • Phone: 305-453-3337
  • Fax: 305-453-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH8222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: