Gary A. Johnson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

22894 Issued in OR

Practice address

417 E Powell Blvd
Gresham, OR 97030-7609

Phone

(503) 665-2517

Fax

(503) 667-3239

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 1983

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e
• WA PPO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Johnson Chiropractic Clinic PC

  • Chiropractor
  • Gresham, OR
  • NPI 1659554632
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1033268404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 E POWELL BLVD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307609",
            "telephone_number": "503-665-2517",
            "fax_number": "503-667-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 E POWELL BLVD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307609",
            "telephone_number": "503-665-2517",
            "fax_number": "503-667-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GARY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "22894",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "OR",
            "license": "22894",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clotilde Amelia Johnson-Beale, M.D., M.P.H.
• Dawn Marie Johnson, PHARM D
• Debra F Johnson, FNP
• Emily Ann Johnson, QMHP-R
• Erica Johnson, DPT
• Gordon Johnson, MD
• Izabella Johnson, QMHA-SOCIAL WORK
• Jack Eugene Johnson Sr., CADC II/QMHP-C, CSWA
• Jacob O Johnson
• Jacquelyn L Johnson, CADC II/QMHA-II

• Chiropractor in Gresham, OR
• Providers in Gresham, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.