Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH60434321 | WA |
NPI | 1003238148 |
---|---|
Provider Name | Dr. David Isaac Johnson |
First Address | Vancouver, WA 98686-4008 |
Second Address | Vancouver, WA 98686-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2014 |
Last Update Date | 08/01/2014 |