Provider Demographics
NPI:1265747455
Name:JOHNSON, CRAIG STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEVEN
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-0095
Mailing Address - Country:US
Mailing Address - Phone:612-298-0792
Mailing Address - Fax:
Practice Address - Street 1:93 OAK AVE S
Practice Address - Street 2:SUITE 2
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302-1205
Practice Address - Country:US
Practice Address - Phone:612-298-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor