Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3722 | KS |
NPI | 1326143066 |
---|---|
Provider Name | David L Johnson |
First Address | Wichita, KS 67218-2325 |
Second Address | Wichita, KS 67218-2325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7288JOH | BCBS (01) | KS |