Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC2219 | NM |
NPI | 1003463878 |
---|---|
Provider Name | Dr. Alexander David Johnson |
First Address | Albuquerque, NM 87111-1648 |
Second Address | Albuquerque, NM 87111-1648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 26/08/2019 |