Provider Demographics
NPI:1598765448
Name:JOHNSON, CHRISTOPHER ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALAN
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 1:1575 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4238
Mailing Address - Country:US
Mailing Address - Phone:651-228-1156
Mailing Address - Fax:651-228-3040
Practice Address - Street 1:1575 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4238
Practice Address - Country:US
Practice Address - Phone:651-228-1156
Practice Address - Fax:651-228-3040
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN293825100Medicaid
MN350003401Medicare ID - Type Unspecified
MNU99062Medicare UPIN