Provider Demographics
NPI:1538273339
Name:JOHNSON, JEFFREY P (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
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 1:401 JOHNSON LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-6280
Mailing Address - Country:US
Mailing Address - Phone:941-484-5333
Mailing Address - Fax:941-488-2834
Practice Address - Street 1:401 JOHNSON LN
Practice Address - Street 2:SUITE 101
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-6280
Practice Address - Country:US
Practice Address - Phone:941-484-5333
Practice Address - Fax:941-488-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70842ZMedicare ID - Type Unspecified
FLT84536Medicare UPIN