1497943153 NPI number — DR. JERRY STANLEY JOHNSTONE II D.C.

Table of content: DR. JERRY STANLEY JOHNSTONE II D.C. (NPI 1497943153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497943153 NPI number — DR. JERRY STANLEY JOHNSTONE II D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTONE
Provider First Name:
JERRY
Provider Middle Name:
STANLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSTONE
Provider Other First Name:
JEREMY
Provider Other Middle Name:
STANLEY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497943153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 SR 9 NE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
LAKE STEVENS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98258-8523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-334-1874
Provider Business Mailing Address Fax Number:
425-334-3852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 SR 9 NE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-8523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-334-1874
Provider Business Practice Location Address Fax Number:
425-334-3852
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00003108 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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