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General NPI Number Information
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NPI Number | 1417220203
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Entity Type | Organization
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Legal Business Name | JOHNSON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 1935 AVENUE D
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City | KATY
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State | TX
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Zip | 77493-1658
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Country | US
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Telephone | 281-693-6310
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Fax | 281-693-6320
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Provider Business Mailing Address
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Address Line | 1935 AVENUE D
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City | KATY
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State | TX
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Zip | 77493-1658
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Country | US
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Telephone | 281-693-6310
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Fax | 281-693-6320
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Authorized Official
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Title or Position | OWNER AND PROVIDER
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Name | JASON P JOHNSON
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Credential | DC
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Telephone | 281-693-6310
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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 | 10918
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License Number State | TX
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