Provider Demographics
NPI:1770593964
Name:JOHNSON, RYAN M (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
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 1:4507 W COTTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2193
Mailing Address - Country:US
Mailing Address - Phone:605-271-0840
Mailing Address - Fax:
Practice Address - Street 1:4627 W HOMEFIELD DR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3511
Practice Address - Country:US
Practice Address - Phone:605-336-2010
Practice Address - Fax:605-336-0249
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor