Provider Demographics
NPI:1477104248
Name:JOHNSON, ISAAC GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:GEORGE
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 1:611 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4938
Mailing Address - Country:US
Mailing Address - Phone:605-882-0100
Mailing Address - Fax:605-882-6911
Practice Address - Street 1:611 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4938
Practice Address - Country:US
Practice Address - Phone:605-882-0100
Practice Address - Fax:605-882-6911
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1355OtherLICENSE NUMBER