Provider Demographics
NPI:1902873193
Name:JOHNSON, JAMES LOREN JR (DC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LOREN
Last Name:JOHNSON
Suffix:JR
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:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834
Mailing Address - Country:US
Mailing Address - Phone:307-684-8888
Mailing Address - Fax:307-684-8882
Practice Address - Street 1:963 FORT ST
Practice Address - Street 2:4
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834
Practice Address - Country:US
Practice Address - Phone:307-684-8888
Practice Address - Fax:307-684-8882
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308612Medicare ID - Type Unspecified