Provider Demographics
NPI:1194712646
Name:JOHNSON, JOEL ELVIN (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ELVIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13720 E 86TH ST N
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8704
Mailing Address - Country:US
Mailing Address - Phone:918-274-3888
Mailing Address - Fax:918-274-3894
Practice Address - Street 1:13720 E 86TH ST N
Practice Address - Street 2:SUITE 130
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8704
Practice Address - Country:US
Practice Address - Phone:918-274-3888
Practice Address - Fax:918-274-3894
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4100111N00000X
OK3999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4536OtherPREFERRED HEALTH SYSTEMS
KS990005093OtherRAILROAD MEDICARE PROV #
KS60423OtherBCBS OF KS PROVIDER #
KS4536OtherPREFERRED HEALTH SYSTEMS
KS060423Medicare PIN