Provider Demographics
NPI:1154407989
Name:JOHNSON, TRECIA SUE (DC)
Entity type:Individual
Prefix:DR
First Name:TRECIA
Middle Name:SUE
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 1:613 18TH AVE NO
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701
Mailing Address - Country:US
Mailing Address - Phone:662-327-8232
Mailing Address - Fax:662-328-6794
Practice Address - Street 1:613 18TH AVE NO
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701
Practice Address - Country:US
Practice Address - Phone:662-327-8232
Practice Address - Fax:662-328-6794
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS961111N00000X
AK390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02511OtherMC GROUP ID
C02511OtherMC GROUP ID