Provider Demographics
NPI:1366715377
Name:JOHNSON CHIROPRACTIC CLINIC, PLLC
Entity type:Organization
Organization Name:JOHNSON CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MESHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-597-4445
Mailing Address - Street 1:1220 S CONGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2035
Mailing Address - Country:US
Mailing Address - Phone:615-597-4445
Mailing Address - Fax:615-597-4477
Practice Address - Street 1:1220 S CONGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2035
Practice Address - Country:US
Practice Address - Phone:615-597-4445
Practice Address - Fax:615-597-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3971624Medicare PIN