MEDICARE: JOHNSTONE CHIROPRACTIC 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
1	111N00000X	Chiropractor	CH00003108	WA

General Provider Information

NPI Number	:	1417120957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSTONE CHIROPRACTIC INC PS

Provider Business Mailing Address
First Line	:	515 STATE ROUTE 9 NE
Second Line	:	SUITE 105
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8523
Country	:	US
Telephone Number	:	425-334-1874
Fax Number	:	425-334-3852

Provider Business Practice Location Address
First Line	:	515 STATE ROUTE 9 NE
Second Line	:	SUITE 105
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8523
Country	:	US
Telephone Number	:	425-334-1874
Fax Number	:	425-334-3852

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY STANLEY JOHNSTON II
Credential	:	DC
Telephone Number	:	425-334-1874

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/13/2011

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