Provider Demographics
NPI:1417248402
Name:JOHNSON, ANNA CORINNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:CORINNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-2140
Mailing Address - Country:US
Mailing Address - Phone:616-523-6472
Mailing Address - Fax:616-523-6473
Practice Address - Street 1:2406 S STATE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-2140
Practice Address - Country:US
Practice Address - Phone:616-523-6472
Practice Address - Fax:616-523-6473
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009846111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor