Healthcare Provider Details

I. General information

NPI: 1891021143
Provider Name (Legal Business Name): JOHNSON CHIROPRATIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W FETTERMAN ST
BUFFALO WY
82834-2413
US

IV. Provider business mailing address

PO BOX 423
BUFFALO WY
82834-0423
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-8888
  • Fax: 307-684-8882
Mailing address:
  • Phone: 307-684-8888
  • Fax: 307-684-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number592
License Number StateWY

VIII. Authorized Official

Name: JAMES L. JOHNSON JR.
Title or Position: OWNER
Credential: D.C.
Phone: 307-684-8888