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General NPI Number Information
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NPI Number | 1669421426
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Entity Type | Individual
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Provider Name | TIMOTHY EDWARD JOHNSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2117 49TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-5233
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Country | US
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Telephone | 727-327-0721
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Fax | 727-327-2875
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Provider Business Mailing Address
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Address Line | 2117 49TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-5233
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Country | US
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Telephone | 727-327-0721
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Fax | 727-327-2875
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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 | CH 5765
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License Number State | FL
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