=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558498659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEAN EARL JOHNSON D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5910 S UNIVERSITY BLVD SUITE A2
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80121-2879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-797-1757
-----------------------------------------------------
Fax | 303-797-8187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5910 S UNIVERSITY BLVD SUITE A2
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80121-2879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-797-1757
-----------------------------------------------------
Fax | 303-797-8187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1958
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------