=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023165735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHNSTON HEALTHCARE ENTERPRISES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 03/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2540 E PLANO PKWY STE 142
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75074-7523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-881-4343
-----------------------------------------------------
Fax | 972-881-4343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2540 E PLANO PKWY STE 142
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75074-7523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-881-4343
-----------------------------------------------------
Fax | 972-881-4343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DR. LAURA F SHWALUK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 972-881-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 7064
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------