Provider Demographics
NPI:1003911108
Name:JOHNSON, KIMBERLY ANN (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
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 1:2516 FRIENDSHIP LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4247
Mailing Address - Country:US
Mailing Address - Phone:952-435-6557
Mailing Address - Fax:952-445-7893
Practice Address - Street 1:1240 3RD AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1679
Practice Address - Country:US
Practice Address - Phone:952-445-7890
Practice Address - Fax:953-445-7893
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor