Provider Demographics
NPI:1942293345
Name:JOHNS, MATTHEW L (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:JOHNS
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 1:4818 S 76TH ST STE 12
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4362
Mailing Address - Country:US
Mailing Address - Phone:414-321-2273
Mailing Address - Fax:414-321-5552
Practice Address - Street 1:4818 S 76TH ST STE 12
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4362
Practice Address - Country:US
Practice Address - Phone:414-321-2273
Practice Address - Fax:414-321-5552
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2547-012111N00000X
WI2581111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
35466Medicare ID - Type Unspecified
U11455Medicare UPIN