Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 1544 | OR |
N | 111NS0005X | Chiropractic Sports Physician | 1544 | OR |
NPI | 1275689465 |
---|---|
Provider Name | Dr. Dale Burt Johnston |
First Address | Wilsonville, OR 97070-0691 |
Second Address | Wilsonville, OR 97070-9735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2007 |
Last Update Date | 08/07/2007 |