Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1479 | LA |
NPI | 1366618423 |
---|---|
Provider Name | Dr. Shawn Douglas Johnston |
First Address | Carencro, LA 70520-4008 |
Second Address | Carencro, LA 70520-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 08/03/2016 |