=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659431286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEITH D. JOHNS D.C., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3716 SE INTERNATIONAL WAY
-----------------------------------------------------
City | MILWAUKIE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-659-0073
-----------------------------------------------------
Fax | 503-659-7471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3716 SE INTERNATIONAL WAY
-----------------------------------------------------
City | MILWAUKIE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-659-0073
-----------------------------------------------------
Fax | 503-659-7471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR OF CHIROPRACTIC, OWNER
-----------------------------------------------------
Name | DR. KEITH D JOHNS
-----------------------------------------------------
Credential | DC PC
-----------------------------------------------------
Telephone | 503-659-0073
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0089
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------