Provider Demographics
NPI:1194788968
Name:JOHANNING, CARMEN C (DC)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:C
Last Name:JOHANNING
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 1:12079 FOXFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1017
Mailing Address - Country:US
Mailing Address - Phone:804-364-7201
Mailing Address - Fax:804-364-7201
Practice Address - Street 1:3506 W CARY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2761
Practice Address - Country:US
Practice Address - Phone:804-359-6999
Practice Address - Fax:804-359-6987
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor