Provider Demographics
NPI:1962490490
Name:JOHNSON, ALAN L (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
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:W69N968 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-3207
Mailing Address - Country:US
Mailing Address - Phone:262-375-4001
Mailing Address - Fax:262-375-4206
Practice Address - Street 1:W69N968 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-3207
Practice Address - Country:US
Practice Address - Phone:262-375-4001
Practice Address - Fax:262-375-4206
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1821-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69295Medicare UPIN
WI75741Medicare ID - Type Unspecified