Johnson Chiropractic Center, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

16072 Issued in AR

Legal business name

JOHNSON CHIROPRACTIC CENTER, LLC

Practice address

2630 E Citizens Dr Ste 6
Fayetteville, AR 72703-4797

Phone

(479) 709-2014

NPI assigned

May 12, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Brock Johnson, D.C.NPI 1992197180

Title

Owner, Ceo

Phone

(479) 935-6021

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brock Johnson, DC

  • Chiropractor
  • Fayetteville, AR
  • NPI 1992197180
  Medicare reassignment Authorized official
• Icem E Brewer, O.D.

  • Corneal and Contact Management Optometrist
  • Fayetteville, AR
  • NPI 1316166697
  NPD (past)
• Michael Waggoner, O.D.

  • Optometrist
  • Fayetteville, AR
  • NPI 1639185341
  NPD (past)

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

{
    "created_epoch": "1526083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668038400000",
    "number": "1154811412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 E CITIZENS DR STE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034797",
            "telephone_number": "479-709-2014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 E CITIZENS DR STE 6",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034797",
            "telephone_number": "479-709-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON CHIROPRACTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-12",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BROCK",
        "authorized_official_title_or_position": "OWNER, CEO",
        "authorized_official_telephone_number": "479-935-6021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "16072",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Shuler LCSW PLLC
• Matt Ryan John, MHPP
• Ravonne John, APRN
• Ashley Nikole Johns
• Jordan Breanne Johnson Bethea, BCBA
• Johnson Prosthetics & Orthotics LLC
• Abigail Speights Johnson, APRN-PMHNP
• Allison M Johnson, M.D.
• Amanda Kelly Johnson, P.T., D.P.T.
• Amy K Johnson, MHPP

• Chiropractor in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Chiropractor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.