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General NPI Number Information
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NPI Number | 1952265779
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Entity Type | Individual
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Provider Name | JUSTIN BLAKE JOHNSON DC
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Gender | Male
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 810 N PLANO RD STE 230
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City | RICHARDSON
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State | TX
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Zip | 75081-3854
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Country | US
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Telephone | 972-907-2800
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Fax | 972-907-2801
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Provider Business Mailing Address
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Address Line | 3200 MCKINNEY AVE APT 629
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City | DALLAS
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State | TX
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Zip | 75204-3027
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Country | US
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Telephone | 972-907-2800
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Fax | 972-907-2801
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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 | 16714
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License Number State | TX
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