Individual
DR. CHARLES J JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1006 MAIN STREET, SUITE B, IMPERIAL, MO 63052
(636) 461-1800
(636) 461-0581
Mailing address
1006 MAIN STREET, SUITE B, IMPERIAL, MO 63052
(636) 461-1800
(636) 461-0581
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2002018322
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136189
GHP
—
01
—
184750
BCBS OF MO
—
Enumeration date
03/07/2006
Last updated
07/08/2007
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