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NPI Code Detail

MEDICARE: TYRONE D JOHNSON D.C.

MEDICARE: TYRONE D JOHNSON 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
1111N00000XChiropractor4597CO

General Provider Information

NPI Number : 1881972834
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRONE D JOHNSON D.C.
Provider Business Mailing Address
First Line : 3425 AUSTIN BLUFFS PKWY
Second Line : SUITE 110
City : COLORADO SPRINGS
State : CO
Zip : 80918-5723
Country : US
Telephone Number : 719-630-0254
Fax Number :
Provider Business Practice Location Address
First Line : 3425 AUSTIN BLUFFS PKWY
Second Line : SUITE 110
City : COLORADO SPRINGS
State : CO
Zip : 80918-5723
Country : US
Telephone Number : 719-630-0254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2011
Last Update Date : 04/25/2012

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