Individual
DR. JEREMY RAY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
4155 N STEELE BLVD STE 10, FAYETTEVILLE, AR 72703-5377
(501) 454-9961
Mailing address
4155 N STEELE BLVD STE 10, FAYETTEVILLE, AR 72703-5377
(501) 454-9961
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
16246
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16246
CHIROPRACTIC LICENSE
AR
Enumeration date
03/04/2020
Last updated
03/04/2020
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