Provider Demographics
NPI:1225450042
Name:JOHNSON CHIROPRACTIC & ACUPUNCTURE
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:1605-336-2010
Mailing Address - Street 1:4627 W HOMEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3511
Mailing Address - Country:US
Mailing Address - Phone:160-533-6201
Mailing Address - Fax:160-533-6024
Practice Address - Street 1:4627 W HOMEFIELD DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3511
Practice Address - Country:US
Practice Address - Phone:160-533-6201
Practice Address - Fax:160-533-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD602111N00000X
SD1070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7600882Medicaid
SD7604450Medicaid