Provider Demographics
NPI:1063697209
Name:JOHNSON, JERRI (DC)
Entity type:Individual
Prefix:DR
First Name:JERRI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 M D LOVE FWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2318
Mailing Address - Country:US
Mailing Address - Phone:214-330-9596
Mailing Address - Fax:214-330-9588
Practice Address - Street 1:5801 M D LOVE FWY
Practice Address - Street 2:SUITE 305
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2318
Practice Address - Country:US
Practice Address - Phone:214-330-9596
Practice Address - Fax:214-330-9588
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608021OtherBLUE CROSS BLUE SHIELD
TX608021OtherBLUE CROSS BLUE SHIELD