Provider Demographics
NPI:1881675106
Name:JOHNSON, SCOTT MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:JOHNSON
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 1:7343 E CAMELBACK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3442
Mailing Address - Country:US
Mailing Address - Phone:480-306-7227
Mailing Address - Fax:480-306-7238
Practice Address - Street 1:4432 N MILLER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3697
Practice Address - Country:US
Practice Address - Phone:480-945-0008
Practice Address - Fax:480-306-7238
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427075100OtherCORPORATE NPI
AZAZ0938440OtherBLUE CROSS BLUE SHIELD AZ
AZ1851658785OtherCORPORATE NPI
1881675106OtherINDIVIDUAL NPI
AZZ75348Medicare ID - Type UnspecifiedPROVIDER NUMBER
1881675106OtherINDIVIDUAL NPI