Provider Demographics
NPI:1548533490
Name:JOHNSTON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:JOHNSTON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:509-529-6200
Mailing Address - Street 1:216 N ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2537
Mailing Address - Country:US
Mailing Address - Phone:509-529-6200
Mailing Address - Fax:509-529-6200
Practice Address - Street 1:216 N ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2537
Practice Address - Country:US
Practice Address - Phone:509-529-6200
Practice Address - Fax:509-529-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2196305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001300234Medicare UPIN
WAT02496Medicare PIN