MEDICARE: JOE W JOHNSON DC LLC

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

General Provider Information

NPI Number	:	1952645335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOE W JOHNSON DC LLC

Provider Business Mailing Address
First Line	:	PO BOX 486
Second Line	:
City	:	PAXTON
State	:	FL
Zip	:	32538-0486
Country	:	US
Telephone Number	:	850-834-2118
Fax Number	:	850-834-3110

Provider Business Practice Location Address
First Line	:	22395 US HIGHWAY 331 N
Second Line	:
City	:	LAUREL HILL
State	:	FL
Zip	:	32567-3309
Country	:	US
Telephone Number	:	850-834-2118
Fax Number	:	850-834-3110

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOE WESLEY JOHNSON
Credential	:	DC
Telephone Number	:	850-834-2118

Provider Enumeration Date	:	11/25/2012
Last Update Date	:	11/25/2012

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Directions to “JOE W JOHNSON DC LLC ” Practice Location

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