Healthcare Provider Details

I. General information

NPI: 1275695439
Provider Name (Legal Business Name): DLJOHNSON, INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 182ND AVE E SUITE D
LAKE TAPPS WA
98391-5704
US

IV. Provider business mailing address

314 182ND AVE E SUITE D
LAKE TAPPS WA
98391-5704
US

V. Phone/Fax

Practice location:
  • Phone: 253-862-7196
  • Fax: 253-862-7290
Mailing address:
  • Phone: 253-862-7196
  • Fax: 253-862-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00002492
License Number StateWA

VIII. Authorized Official

Name: DR. DAVID LOREN JOHNSON
Title or Position: PRESIDENT
Credential: DC
Phone: 253-862-7196