Provider Demographics
NPI:1366587420
Name:JOHNSTON, PAUL F (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
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 1:9141 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2940
Mailing Address - Country:US
Mailing Address - Phone:318-687-9671
Mailing Address - Fax:318-687-9691
Practice Address - Street 1:9141 WALKER RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2940
Practice Address - Country:US
Practice Address - Phone:318-687-9671
Practice Address - Fax:318-687-9691
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA359OtherLICENSES
LA20294OtherBLUE CROSS BLUE SHIELD
LA1950181Medicaid
LA720957373OtherTAX ID
LA359OtherLICENSES
LA59021Medicare ID - Type Unspecified