Provider Demographics
NPI:1891902888
Name:JOHNSON, MICHAEL LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
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 1:2000 S MEMORIAL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1237
Mailing Address - Country:US
Mailing Address - Phone:920-739-6971
Mailing Address - Fax:920-739-0224
Practice Address - Street 1:2000 S MEMORIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1237
Practice Address - Country:US
Practice Address - Phone:920-739-6971
Practice Address - Fax:920-739-0224
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1822111NR0400X, 171400000X, 172M00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No171400000XOther Service ProvidersHealth & Wellness Coach
No172M00000XOther Service ProvidersMechanotherapist