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General NPI Number Information
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NPI Number | 1164458469
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Entity Type | Organization
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Legal Business Name | JOHNSTON CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 1150 GROVE ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2914
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Country | US
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Telephone | 805-541-2727
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Fax | 805-541-2729
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Provider Business Mailing Address
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Address Line | 1150 GROVE ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2914
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Country | US
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Telephone | 805-541-2727
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Fax | 805-541-2729
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | R. MARC JOHNSTON
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Credential | D.C., Q.M.E.
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Telephone | 805-541-2727
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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 | 11453
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License Number State | CA
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