Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH5495 | FL |
N | 111NN0400X | Neurology | CH5495 | FL |
NPI | 1669448155 |
---|---|
Provider Name | Dr. Larry Dean Johnson |
First Address | Cape Coral, FL 33990-1715 |
Second Address | Cape Coral, FL 33990-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 17/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350053600 | RAILROAD MEDICARE (01) | |
381717200 | (05) | FL |
T55086 | (02) |