Provider Demographics
NPI:1215085634
Name:JOHNSON, GEORGE GARY (DC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:GARY
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 1:270 S. COLLINS ROAD
Mailing Address - Street 2:STE. 200
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4625
Mailing Address - Country:US
Mailing Address - Phone:972-226-4444
Mailing Address - Fax:972-203-1914
Practice Address - Street 1:270 S. COLLINS ROAD
Practice Address - Street 2:STE. 200
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4625
Practice Address - Country:US
Practice Address - Phone:972-226-4444
Practice Address - Fax:972-203-1914
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150683401Medicaid
TX609693Medicare ID - Type Unspecified
TXU88409Medicare UPIN