Provider Demographics
NPI:1992974745
Name:JOHNSON, KERI (DC)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 HOLLAND DR APT 18D
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6387
Mailing Address - Country:US
Mailing Address - Phone:714-507-8267
Mailing Address - Fax:
Practice Address - Street 1:45 RINCON DR
Practice Address - Street 2:EXECUTIVE SUITE 103-1B
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8413
Practice Address - Country:US
Practice Address - Phone:805-987-6700
Practice Address - Fax:805-987-6733
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor