MEDICARE: DR. JERRY STANLEY JOHNSTONE II D.C.

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	:	1497943153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY STANLEY JOHNSTONE II D.C.

Provider Business Mailing Address
First Line	:	515 SR 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 SR 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	04/21/2011

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