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General NPI Number Information
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NPI Number | 1326431727
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Entity Type | Organization
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Legal Business Name | JOHNSON CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 4205 HWY 314 SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-9768
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Country | US
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Telephone | 505-565-0548
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 922
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City | LOS LUNAS
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State | NM
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Zip | 87031-0922
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Country | US
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Telephone | 505-565-0548
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. HARVEY JAMES JOHNSON
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Credential | D.C.
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Telephone | 505-565-0548
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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 | 1373
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License Number State | NM
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