Healthcare Provider Details

I. General information

NPI: 1902873193
Provider Name (Legal Business Name): JAMES LOREN JOHNSON JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 FORT ST 4
BUFFALO WY
82834
US

IV. Provider business mailing address

PO BOX 423
BUFFALO WY
82834
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:
Title or Position:
Credential:
Phone: