Provider Demographics
NPI:1174523955
Name:JOHNSON, ALAN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEE
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 1:703 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5617
Mailing Address - Country:US
Mailing Address - Phone:727-446-2208
Mailing Address - Fax:727-443-0750
Practice Address - Street 1:703 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5617
Practice Address - Country:US
Practice Address - Phone:727-446-2208
Practice Address - Fax:727-443-0750
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4945111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70750Medicare ID - Type Unspecified
T62331Medicare UPIN