Healthcare Provider Details

I. General information

NPI: 1629461025
Provider Name (Legal Business Name): HARVEY JAMES JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 HWY 314 SW
LOS LUNAS NM
87031-9768
US

IV. Provider business mailing address

PO BOX 922
LOS LUNAS NM
87031-0922
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-0548
  • Fax:
Mailing address:
  • Phone: 505-565-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1373
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: