Provider Demographics
NPI:1275108284
Name:JOHNSON, CHRISTOPHER JAMES MANIBUSAN
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JAMES MANIBUSAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051-0584
Mailing Address - Country:US
Mailing Address - Phone:573-263-6427
Mailing Address - Fax:
Practice Address - Street 1:112 CHAMORRO LANE
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051-0584
Practice Address - Country:US
Practice Address - Phone:573-263-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health