Provider Demographics
NPI:1154305449
Name:JOHNSON, MICHAEL D (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
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:PO BOX 305
Mailing Address - Street 2:117 W 5TH ST
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-0305
Mailing Address - Country:US
Mailing Address - Phone:320-239-4848
Mailing Address - Fax:320-239-2898
Practice Address - Street 1:117 W 5TH ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-2426
Practice Address - Country:US
Practice Address - Phone:320-239-4848
Practice Address - Fax:320-239-2898
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U43013Medicare UPIN