Provider Demographics
NPI:1861531261
Name:JOHNSTON, DANIEL BRENT (DC DOCTOR OF CHIROPR)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRENT
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1503
Mailing Address - Country:US
Mailing Address - Phone:509-662-9571
Mailing Address - Fax:509-662-6982
Practice Address - Street 1:416 9TH ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1503
Practice Address - Country:US
Practice Address - Phone:509-662-9571
Practice Address - Fax:509-662-6982
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA350055357OtherRR MEDICARE
WA158239OtherWA DEPT OF LABOR & INDUST
WA8346066Medicaid
AB272821Medicare UPIN
WA158239OtherWA DEPT OF LABOR & INDUST