Provider Demographics
NPI:1477086486
Name:JOHNSON, EMILY JOHANNA (DC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOHANNA
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 1:16645 W GREENFIELD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1546
Mailing Address - Country:US
Mailing Address - Phone:262-788-5940
Mailing Address - Fax:
Practice Address - Street 1:16645 W GREENFIELD AVE STE D
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1546
Practice Address - Country:US
Practice Address - Phone:262-788-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086694111N00000X
WI5271-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor