Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 3812 | AZ |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC 15470 | CA |
NPI | 1215962444 |
---|---|
Provider Name | Dr. Benjamin Dean Johnson |
First Address | Glendora, CA 91740-1619 |
Second Address | Glendora, CA 91740-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 12/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7906627 | (05) | CA |
DC15470 | (02) | CA |