Individual
CHANLER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
236 LORRAINE AVE, WAUKEGAN, IL 60085-3620
(224) 302-2169
Mailing address
236 LORRAINE AVE, WAUKEGAN, IL 60085-3620
(224) 302-2169
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
DO NOT HAVE MEDICARE
AL
Enumeration date
01/17/2023
Last updated
01/17/2023
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