Provider Demographics
NPI:1821090770
Name:JOHNSON, KAY DEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:DEE
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 1:102 SHERIDAN ST W
Mailing Address - Street 2:
Mailing Address - City:LANESBORO
Mailing Address - State:MN
Mailing Address - Zip Code:55949-9725
Mailing Address - Country:US
Mailing Address - Phone:507-467-2629
Mailing Address - Fax:507-467-2638
Practice Address - Street 1:102 SHERIDAN ST W
Practice Address - Street 2:
Practice Address - City:LANESBORO
Practice Address - State:MN
Practice Address - Zip Code:55949-9725
Practice Address - Country:US
Practice Address - Phone:507-467-2629
Practice Address - Fax:507-467-2638
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN148R9RIOtherBCBS INDIVIDUAL #
MN148R8RIOtherBCBS GROUP #