Healthcare Provider Details

I. General information

NPI: 1841296803
Provider Name (Legal Business Name): LORI DELIGHT JOHNSON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1420 ROOSEVELT AVE STE 7
MOUNT VERNON WA
98273-2687
US

IV. Provider business mailing address

2118 RIVERSIDE DR STE 105
MOUNT VERNON WA
98273-5454
US

V. Phone/Fax

Practice location:
  • Phone: 360-941-0505
  • Fax: 360-399-7484
Mailing address:
  • Phone: 360-424-6104
  • Fax: 360-424-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00001908
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: