Provider Demographics
NPI:1982958666
Name:JOHNSON, THOMAS MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARTIN
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 1:55 ROLLING OAKS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1010
Mailing Address - Country:US
Mailing Address - Phone:805-499-4446
Mailing Address - Fax:805-230-2133
Practice Address - Street 1:2806 TOWNSGATE RD STE B
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3066
Practice Address - Country:US
Practice Address - Phone:805-494-9977
Practice Address - Fax:805-494-8558
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27711111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAES855ZMedicare PIN