Provider Demographics
NPI:1730221425
Name:JOHNSON, WILLIAM JAMES (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
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 1:19022 AVENUE OF THE OAKS
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1444
Mailing Address - Country:US
Mailing Address - Phone:661-296-1291
Mailing Address - Fax:661-254-0824
Practice Address - Street 1:26111 BOUQUET CYN. RD. G-3
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3712
Practice Address - Country:US
Practice Address - Phone:661-255-8099
Practice Address - Fax:661-254-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC13806OtherLICENSE NUMBER
CADC13806OtherLICENSE NUMBER