Provider Demographics
NPI:1841414323
Name:JOHNSTON, MICHAEL TROY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TROY
Last Name:JOHNSTON
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 1:13079 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-9019
Mailing Address - Country:US
Mailing Address - Phone:763-428-8102
Mailing Address - Fax:
Practice Address - Street 1:21370 JOHN MILLESS DR
Practice Address - Street 2:#215
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9449
Practice Address - Country:US
Practice Address - Phone:763-428-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU74640Medicare UPIN
MN350002870Medicare ID - Type Unspecified