Provider Demographics
NPI:1487787891
Name:JOHNSON, RANDAL CURTIS (DC)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:CURTIS
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 1:54 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9552
Mailing Address - Country:US
Mailing Address - Phone:831-659-5043
Mailing Address - Fax:
Practice Address - Street 1:1398 MUNRAS AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6139
Practice Address - Country:US
Practice Address - Phone:831-375-2238
Practice Address - Fax:831-375-2240
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15965111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770121893OtherTAX ID #
CAAC0159651Medicare ID - Type Unspecified