Healthcare Provider Details

I. General information

NPI: 1891792131
Provider Name (Legal Business Name): ROBERT TOVEY JOHNSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 HEMLOCK ST STE 3B
BROOKINGS OR
97415-9425
US

IV. Provider business mailing address

1043 CHETCO AVE # 141
BROOKINGS OR
97415-7152
US

V. Phone/Fax

Practice location:
  • Phone: 541-708-2060
  • Fax: 541-982-7019
Mailing address:
  • Phone: 541-708-2060
  • Fax: 541-982-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-26289
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3498
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: