Healthcare Provider Details

I. General information

NPI: 1780238766
Provider Name (Legal Business Name): GARTH JOHNSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GARTH JOHNSON DC

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LAFAYETTE ST
PITTSBURG TX
75686-1630
US

IV. Provider business mailing address

DBA CAMP COUNTY CLINIC OF CHIROPRACTIC & REHAB 210 LAFAYETTE ST
PITTSBURG TX
75686-1630
US

V. Phone/Fax

Practice location:
  • Phone: 903-856-3665
  • Fax:
Mailing address:
  • Phone: 903-856-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14179
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: