Provider Demographics
NPI:1932847381
Name:JOHNSON, CAMERON ROBERT (DC)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ROBERT
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 1:3201 BEE CAVES RD STE 121
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7060
Mailing Address - Country:US
Mailing Address - Phone:512-987-4409
Mailing Address - Fax:512-233-2657
Practice Address - Street 1:3201 BEE CAVES RD STE 121
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7060
Practice Address - Country:US
Practice Address - Phone:512-987-4409
Practice Address - Fax:512-233-2657
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15173111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician