Active NPI
Bob J Johnson, DC
- Chiropractor
- San Diego, CA
National Provider Identifier
1285648402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 17721
- Practice address
- 9550 Black Mountain Rd Ste E
San Diego, CA 92126-4577 - Phone
- (858) 578-5776
- NPI assigned
- Jul 27, 2006
- 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 | 17721 | CA | Primary |
Addresses
Primary practice location
9550 Black Mountain Rd Ste E
San Diego, CA 92126-4577
Mailing address
10770 Black Mountain Rd SPC 277
San Diego, CA 92126-2951
Phone (858) 863-6419
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060914000429 | CA | Practitioner - Chiropractic | 5799789251 | Practice locations: San Diego, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Los Angeles College of Chiropractic, 1986
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
9550 Black Mountain Rd
Suite E
San Diego, CA 92126-4577
Phone (858) 578-5776
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681171200000",
"number": "1285648402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10770 BLACK MOUNTAIN RD SPC 277",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921262951",
"telephone_number": "858-863-6419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9550 BLACK MOUNTAIN RD STE E",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921264577",
"telephone_number": "858-578-5776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "BOB",
"middle_name": "J",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2023-04-11",
"certification_date": "2021-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "17721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; 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.