Provider Demographics
NPI:1013061233
Name:JOHNSON, ERIK NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:NEIL
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 1:101 WEST MAIN ST.
Mailing Address - Street 2:PO BOX 297
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-0297
Mailing Address - Country:US
Mailing Address - Phone:605-356-2688
Mailing Address - Fax:605-356-2315
Practice Address - Street 1:101 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK POINT
Practice Address - State:SD
Practice Address - Zip Code:57025-0297
Practice Address - Country:US
Practice Address - Phone:605-356-2688
Practice Address - Fax:605-356-2315
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601560Medicaid
SD7601560Medicaid
SDS40597Medicare PIN