Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHR6922 | CO |
NPI | 1063766723 |
---|---|
Provider Name | Dr. Clyde Francis Johnson |
First Address | Greenwood Village, CO 80111-5170 |
Second Address | Centennial, CO 80122-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2012 |
Last Update Date | 29/01/2015 |