Doctor Name: | DR. GARY L JOHNSON |
NPI Number: | 1588721930 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | CHIA -958 |
Business Practice Address: | 2745 Pole Line Rd Pocatello, ID - 83201 |
Business Phone Number: | 2084785554 |
Business Fax Number: | 2084785556 |
Mailing Address: | 2745 Pole Line Rd., POCATELLO |
State: | ID |
Postal Code: | 832016111 |
Phone Number: | 2084785554 |
Fax Number: | 2084785556 |
NPI Enumeration Date: | 01/03/2007 |
NPI Last Update Date: | 12/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | CHIA -958 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |