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General NPI Number Information
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NPI Number | 1689731564
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Entity Type | Individual
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Provider Name | ROBERTA MICHELLE JOHNSON D.C.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6059 S QUEBEC ST SUITE 103
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City | CENTENNIAL
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State | CO
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Zip | 80111-4514
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Country | US
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Telephone | 303-741-1181
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Fax | 303-741-1191
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Provider Business Mailing Address
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Address Line | 6059 S QUEBEC ST SUITE 103
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City | CENTENNIAL
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State | CO
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Zip | 80111-4514
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Country | US
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Telephone | 303-741-1181
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Fax | 303-741-1191
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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 | 4885
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License Number State | CO
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