Provider Demographics
NPI:1073054664
Name:JOHNSON, ERIC JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7818 BIG SKY DRIVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:608-203-9272
Mailing Address - Fax:608-203-9271
Practice Address - Street 1:7818 BIG SKY DR
Practice Address - Street 2:SUITE 215
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3524
Practice Address - Country:US
Practice Address - Phone:608-203-9272
Practice Address - Fax:608-203-9271
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5260-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor