Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1602 | OH |
N | 111N00000X | Chiropractor | 4110 | KY |
NPI | 1003912478 |
---|---|
Provider Name | Brian W Johnson |
First Address | Cinti, OH 45251 |
Second Address | Cincinnati, OH 45251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000336270 | ANTHEM BCBS (01) |