Provider Demographics
NPI:1164586590
Name:JOHNSON, SCOTT A (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
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 1:611 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4938
Mailing Address - Country:US
Mailing Address - Phone:605-882-0100
Mailing Address - Fax:605-882-6911
Practice Address - Street 1:611 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4938
Practice Address - Country:US
Practice Address - Phone:605-882-0100
Practice Address - Fax:605-882-6911
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7602182Medicaid
SD41524Medicare ID - Type Unspecified