Provider Demographics
NPI:1396379491
Name:JOHNSON CHIROPRACTIC HEALTH CENTER PLLC
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-321-5243
Mailing Address - Street 1:5021 W ST JOE HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4027
Mailing Address - Country:US
Mailing Address - Phone:517-321-5243
Mailing Address - Fax:
Practice Address - Street 1:5021 W ST JOE HWY STE 6
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4027
Practice Address - Country:US
Practice Address - Phone:517-321-5243
Practice Address - Fax:517-321-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI363704874Medicaid