Provider Demographics
NPI:1346385499
Name:JOHNSON, BRET ZACHARY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:ZACHARY
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 1:195 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-5976
Mailing Address - Country:US
Mailing Address - Phone:920-960-5349
Mailing Address - Fax:
Practice Address - Street 1:195 EAST 14TH ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54936-1451
Practice Address - Country:US
Practice Address - Phone:920-960-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4292-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor