Healthcare Provider Details

I. General information

NPI: 1720586340
Provider Name (Legal Business Name): CHRISTIAN L JOHNSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 STRAUSS AVE
SANDY OR
97055-8060
US

IV. Provider business mailing address

20145 NE SANDY BLVD UNIT 66
FAIRVIEW OR
97024-9758
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5822
  • Fax: 503-668-3662
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5882
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: