Healthcare Provider Details

I. General information

NPI: 1972996874
Provider Name (Legal Business Name): KARI JOHNSTON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 NW WALLULA AVENUE #316
GRESHAM OR
97030
US

IV. Provider business mailing address

1167 NW WALLULA AVE #316
GRESHAM OR
97030-3666
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-3590
  • Fax:
Mailing address:
  • Phone: 785-527-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60533870
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: