Provider Demographics
NPI:1003408634
Name:JOHNSON, MADISON MAE (DC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SE LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8299
Mailing Address - Country:US
Mailing Address - Phone:515-348-4325
Mailing Address - Fax:515-346-8383
Practice Address - Street 1:60 SE LAUREL ST
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8299
Practice Address - Country:US
Practice Address - Phone:515-348-4325
Practice Address - Fax:515-346-8383
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor