NPIMap

Individual provider Active NPI

David C Johnson, LMT, NCTMB

  • Massage Therapist
  • Troy, IL
National Provider Identifier
1629304712
Registry record updated Oct 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
227010448 Issued in IL
Practice address
102 N Main St
Troy, IL 62294-1129
Phone
(618) 667-9766
Fax
(618) 667-9770
NPI assigned
Oct 23, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 227010448 IL Primary

Addresses

Primary practice location

102 N Main St
Troy, IL 62294-1129

Mailing address

102 N Main St
Troy, IL 62294-1129
Phone (618) 667-9766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
227010448ILMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pathway Chiropractic, P.C. Past Accepting new patients
Johnson Family Chiropractic, Inc. Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256256000000",
    "number": "1629304712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 N MAIN ST",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941129",
            "telephone_number": "618-667-9766",
            "fax_number": "618-667-9770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N MAIN ST",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941129",
            "telephone_number": "618-667-9766",
            "fax_number": "618-667-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAVID",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "LMT, NCTMB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227010448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.