Provider Demographics
NPI:1245855097
Name:JOHNSON, CHRISTOPHER STEWART (DCM, LAC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:STEWART
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8085 WAYZATA BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1472
Mailing Address - Country:US
Mailing Address - Phone:612-567-2270
Mailing Address - Fax:
Practice Address - Street 1:8085 WAYZATA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1472
Practice Address - Country:US
Practice Address - Phone:612-567-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist