Provider Demographics
NPI:1871735183
Name:DR SEAN JOHNSON PA
Entity type:Organization
Organization Name:DR SEAN JOHNSON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-848-3861
Mailing Address - Street 1:1511 PROSPERITY FARMS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2046
Mailing Address - Country:US
Mailing Address - Phone:561-848-3861
Mailing Address - Fax:
Practice Address - Street 1:1511 PROSPERITY FARMS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2046
Practice Address - Country:US
Practice Address - Phone:561-848-3861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU57641Medicare UPIN