Provider Demographics
NPI:1366533911
Name:JOHNSTON, DEREK DONALD (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:DONALD
Last Name:JOHNSTON
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 1:2255 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3195
Mailing Address - Country:US
Mailing Address - Phone:720-626-4799
Mailing Address - Fax:303-776-2912
Practice Address - Street 1:2255 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3195
Practice Address - Country:US
Practice Address - Phone:720-626-4799
Practice Address - Fax:303-776-2912
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-2317952OtherEIN
45-2317952OtherEIN