Provider Demographics
NPI:1699093237
Name:JOHNSON CHIROPRACTIC CENTRE
Entity type:Organization
Organization Name:JOHNSON CHIROPRACTIC CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-623-1191
Mailing Address - Street 1:358 RUSSELL RD NW
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2761
Mailing Address - Country:US
Mailing Address - Phone:276-623-1191
Mailing Address - Fax:276-628-2955
Practice Address - Street 1:358 RUSSELL RD NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2761
Practice Address - Country:US
Practice Address - Phone:276-623-1191
Practice Address - Fax:276-628-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty