Healthcare Provider Details

I. General information

NPI: 1184741530
Provider Name (Legal Business Name): TODD D JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N MAIN ST
GUYMON OK
73942-3611
US

IV. Provider business mailing address

1001 N MAIN ST PO BOX 161
GUYMON OK
73942-3611
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-2070
  • Fax: 580-468-1715
Mailing address:
  • Phone: 580-338-2070
  • Fax: 580-468-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3456
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: