Provider Demographics
NPI:1871639120
Name:JOHNSON, MARJORIE ROSENGREN (DC, PHD)
Entity Type:Individual
Prefix:PROF
First Name:MARJORIE
Middle Name:ROSENGREN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC, PHD
Other - Prefix:DR
Other - First Name:MARJORIE
Other - Middle Name:ROSENGREN
Other - Last Name:KNUTH (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:28012 230TH ST
Mailing Address - Street 2:
Mailing Address - City:LECLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9177
Mailing Address - Country:US
Mailing Address - Phone:563-289-3729
Mailing Address - Fax:563-884-5897
Practice Address - Street 1:1000 BRADY ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-5214
Practice Address - Country:US
Practice Address - Phone:563-884-5744
Practice Address - Fax:563-884-5897
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor