Provider Demographics
NPI:1912073073
Name:JOHNSON, JEFFREY SCOTT (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TOWN AND COUNTRY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3960
Mailing Address - Country:US
Mailing Address - Phone:925-743-8210
Mailing Address - Fax:925-743-8213
Practice Address - Street 1:115 TOWN AND COUNTRY DR
Practice Address - Street 2:SUITE E
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3960
Practice Address - Country:US
Practice Address - Phone:925-743-8210
Practice Address - Fax:925-743-8213
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24925111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician