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General NPI Number Information
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NPI Number | 1255801064
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Entity Type | Organization
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Legal Business Name | DR. JOHNSON'S ADVANCED WELLNESS
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 5005 TEXAS ST STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92108-3722
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Country | US
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Telephone | 619-518-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 TEXAS ST STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92108-3722
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Country | US
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Telephone | 619-518-4222
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. TRAVIS JOHNSON
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Credential | DC
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Telephone | 619-518-4222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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