Healthcare Provider Details

I. General information

NPI: 1659431286
Provider Name (Legal Business Name): KEITH D. JOHNS D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3716 SE INTERNATIONAL WAY
MILWAUKIE OR
97222
US

IV. Provider business mailing address

3716 SE INTERNATIONAL WAY
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-0073
  • Fax: 503-659-7471
Mailing address:
  • Phone: 503-659-0073
  • Fax: 503-659-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0089
License Number StateOR

VIII. Authorized Official

Name: DR. KEITH D JOHNS
Title or Position: DR OF CHIROPRACTIC, OWNER
Credential: DC PC
Phone: 503-659-0073