Provider Demographics
NPI:1164940581
Name:JOHNSON CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-742-5578
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-0072
Mailing Address - Country:US
Mailing Address - Phone:608-472-5578
Mailing Address - Fax:608-742-7028
Practice Address - Street 1:1512 NEW PINERY RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1312
Practice Address - Country:US
Practice Address - Phone:608-742-5578
Practice Address - Fax:608-742-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty