Provider Demographics
NPI:1487721437
Name:DAWSON, JOHNNY K (DC)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:K
Last Name:DAWSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:K
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:590 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE #16
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-963-2266
Mailing Address - Fax:480-917-2039
Practice Address - Street 1:590 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE #16
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-963-2266
Practice Address - Fax:480-917-2039
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0236600OtherBLUE CROSS BLUE SHIELD
AZDC4867Medicare ID - Type Unspecified