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General NPI Number Information
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NPI Number | 1528133238
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Entity Type | Individual
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Provider Name | KELLY D JOHNSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 30313 CANWOOD ST #33
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4326
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Country | US
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Telephone | 818-991-4900
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Fax | 818-991-4509
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Provider Business Mailing Address
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Address Line | 29939 EASTVALE CT
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4422
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Country | US
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Telephone | 818-991-3190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC14646
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License Number State | CA
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