Provider Demographics
NPI:1699777698
Name:JOHNSON, MICHAEL DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
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 1:9924 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4814
Mailing Address - Country:US
Mailing Address - Phone:804-320-9050
Mailing Address - Fax:804-320-9048
Practice Address - Street 1:9924 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4814
Practice Address - Country:US
Practice Address - Phone:804-320-9050
Practice Address - Fax:804-320-9048
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000670111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070327OtherANTHEM
VAC03086Medicare PIN