Healthcare Provider Details

I. General information

NPI: 1861405052
Provider Name (Legal Business Name): PAUL ROBERT JOHNSON JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 BLUE RIDGE BLVD
SENECA SC
29672-6613
US

IV. Provider business mailing address

1741 BLUE RIDGE BLVD
SENECA SC
29672-6613
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-6395
  • Fax: 864-882-9248
Mailing address:
  • Phone: 864-882-6395
  • Fax: 864-882-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number719
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: