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NPI Code Detail

MEDICARE: DLJOHNSON, INC PS

MEDICARE: DLJOHNSON, INC PS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH00002492WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1157839OTHERWAWORKMANS COMP

General Provider Information

NPI Number : 1275695439
Entity Type Code : Organization
Provider Name (Legal Business Name) : DLJOHNSON, INC PS
Provider Business Mailing Address
First Line : 314 182ND AVE E
Second Line : SUITE D
City : LAKE TAPPS
State : WA
Zip : 98391-5704
Country : US
Telephone Number : 253-862-7196
Fax Number : 253-862-7290
Provider Business Practice Location Address
First Line : 314 182ND AVE E
Second Line : SUITE D
City : LAKE TAPPS
State : WA
Zip : 98391-5704
Country : US
Telephone Number : 253-862-7196
Fax Number : 253-862-7290
Authorized Official
Title or Position : PRESIDENT
Name : DR. DAVID LOREN JOHNSON
Credential : DC
Telephone Number : 253-862-7196
Provider Enumeration Date : 12/14/2006
Last Update Date : 08/22/2020

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