Healthcare Provider Details

I. General information

NPI: 1922161595
Provider Name (Legal Business Name): ANDREW I JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N CALUMET RD
CHESTERTON IN
46304-2426
US

IV. Provider business mailing address

114 N CALUMET RD
CHESTERTON IN
46304-2426
US

V. Phone/Fax

Practice location:
  • Phone: 219-926-3310
  • Fax: 219-926-3350
Mailing address:
  • Phone: 219-926-3310
  • Fax: 219-926-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001469A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: