Provider Demographics
NPI:1518017417
Name:JOHNSON, WILLIAM ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERIC
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 1:1512 NEW PINERY RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1312
Mailing Address - Country:US
Mailing Address - Phone:608-742-5578
Mailing Address - Fax:608-742-7028
Practice Address - Street 1:1512 NEW PINERY RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1312
Practice Address - Country:US
Practice Address - Phone:608-742-5578
Practice Address - Fax:608-742-7028
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38792400Medicaid
WI38792400Medicaid
WI75-794Medicare ID - Type Unspecified