Active NPI
Glenn Edwin Johnson, D.C.
- Chiropractor
- Anaheim, CA
National Provider Identifier
1225235997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC17210
- Practice address
- 1665 S Brookhurst St
Suite J
Anaheim, CA 92804-6000 - Phone
- (714) 772-2225
- Fax
- (714) 400-0026
- NPI assigned
- Jun 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC17210 | CA | Primary |
Addresses
Primary practice location
1665 S Brookhurst St
Suite J
Anaheim, CA 92804-6000
Mailing address
1665 S Brookhurst St
Suite J
Anaheim, CA 92804-6000
Phone (714) 772-2225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080227000706 | CA | Practitioner - Chiropractic | 5890879951 | Practice locations: Anaheim, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Cleveland Chiropractic College - Los Angeles, 1985
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
135 S Knot Ave
Anaheim, CA 92804-1406
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC17210 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225235997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1665 S BROOKHURST ST",
"address_2": "SUITE J",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928046000",
"telephone_number": "714-772-2225",
"fax_number": "714-400-0026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1665 S BROOKHURST ST",
"address_2": "SUITE J",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928046000",
"telephone_number": "714-772-2225",
"fax_number": "714-400-0026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "GLENN",
"middle_name": "EDWIN",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC17210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.