Provider Demographics
NPI:1730436791
Name:JOHNSON, JUSTIN DALE (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DALE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:550 STANTON CHRISTIANA RD STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2132
Mailing Address - Country:US
Mailing Address - Phone:302-365-6520
Mailing Address - Fax:302-365-6167
Practice Address - Street 1:2106 SILVERSIDE RD STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4163
Practice Address - Country:US
Practice Address - Phone:302-365-6520
Practice Address - Fax:302-365-6167
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8370668-1202111N00000X
PADC010890111N00000X
DEF10000897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor