Provider Demographics
NPI:1619151222
Name:P SCOTT JOHNSON D C INC
Entity Type:Organization
Organization Name:P SCOTT JOHNSON D C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-824-8183
Mailing Address - Street 1:715 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-1313
Mailing Address - Country:US
Mailing Address - Phone:260-824-8183
Mailing Address - Fax:260-824-8184
Practice Address - Street 1:715 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1313
Practice Address - Country:US
Practice Address - Phone:260-824-8183
Practice Address - Fax:260-824-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1003864440 AMedicaid
IN000000356189OtherANTHEM
IN1003864440 AMedicaid