Provider Demographics
NPI:1548426513
Name:JOHNSON CHIROPRACTIC INC
Entity type:Organization
Organization Name:JOHNSON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-444-1002
Mailing Address - Street 1:471 HERITAGE PARK BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5623
Mailing Address - Country:US
Mailing Address - Phone:801-444-1002
Mailing Address - Fax:801-444-0170
Practice Address - Street 1:471 HERITAGE PARK BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5623
Practice Address - Country:US
Practice Address - Phone:801-444-1002
Practice Address - Fax:801-544-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT952880071202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU53418Medicare UPIN
UT000056077Medicare PIN