Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH60377651 | WA |
NPI | 1003255282 |
---|---|
Provider Name | Dr. Gregory Robert Johnson |
First Address | Federal Way, WA 98003-6357 |
Second Address | Federal Way, WA 98003-6357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 20/06/2013 |