Provider Demographics
NPI:1255456737
Name:KIMBERLY A JOHNSON S.C.
Entity type:Organization
Organization Name:KIMBERLY A JOHNSON S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-426-4200
Mailing Address - Street 1:2210 OMRO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7710
Mailing Address - Country:US
Mailing Address - Phone:920-426-4200
Mailing Address - Fax:920-426-3730
Practice Address - Street 1:2210 OMRO RD
Practice Address - Street 2:SUITE A
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7710
Practice Address - Country:US
Practice Address - Phone:920-426-4200
Practice Address - Fax:920-426-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI2589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881688570OtherNPI
WIU16701Medicare UPIN