Provider Demographics
NPI:1730942673
Name:JOHNSON, DERIAN (DC)
Entity type:Individual
Prefix:
First Name:DERIAN
Middle Name:
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 1:16718 HOUSE HAHL RD STE B1
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6852
Mailing Address - Country:US
Mailing Address - Phone:972-533-2733
Mailing Address - Fax:
Practice Address - Street 1:16718 HOUSE HAHL RD STE B1
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6852
Practice Address - Country:US
Practice Address - Phone:972-533-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor