Provider Demographics
NPI:1831492420
Name:JOHNSON CHIROPRACTIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:JOHNSON CHIROPRACTIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-882-5533
Mailing Address - Street 1:6635 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616-9765
Mailing Address - Country:US
Mailing Address - Phone:231-882-5533
Mailing Address - Fax:231-882-1361
Practice Address - Street 1:6635 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9765
Practice Address - Country:US
Practice Address - Phone:231-882-5533
Practice Address - Fax:231-882-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2001007090111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A05247OtherBCBS
MIMI3580OtherORGANIZATION PTAN
MI1831492420Medicare PIN
MI0A05247OtherBCBS