Healthcare Provider Details

I. General information

NPI: 1871735183
Provider Name (Legal Business Name): DR SEAN JOHNSON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 PROSPERITY FARMS RD SUITE 400
LAKE PARK FL
33403-2046
US

IV. Provider business mailing address

1511 PROSPERITY FARMS RD SUITE 400
LAKE PARK FL
33403-2046
US

V. Phone/Fax

Practice location:
  • Phone: 561-848-3861
  • Fax:
Mailing address:
  • Phone: 561-848-3861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7365
License Number StateFL

VIII. Authorized Official

Name: SEAN JOHNSON
Title or Position: OWNER/DOCTOR
Credential:
Phone: 561-848-3861