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General NPI Number Information
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NPI Number | 1013097708
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Entity Type | Individual
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Provider Name | ROBERT MAX JOHNSON JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1942 ADDISON AVE E # 2
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City | TWIN FALLS
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State | ID
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Zip | 83301-5304
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Country | US
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Telephone | 208-734-8680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 565
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City | TWIN FALLS
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State | ID
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Zip | 83303-0565
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Country | US
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Telephone | 208-734-8680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 721
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License Number State | ID
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