Provider Demographics
NPI:1831196310
Name:JOHNSON, PERRY S (DC)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:S
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 1:1085B N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-1322
Mailing Address - Country:US
Mailing Address - Phone:260-824-8183
Mailing Address - Fax:260-824-8184
Practice Address - Street 1:715 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1313
Practice Address - Country:US
Practice Address - Phone:260-824-8183
Practice Address - Fax:260-824-8184
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN080001137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100386440AMedicaid
IN000000356189OtherANTHEM
INP00182728OtherMEDICARE RR
INP00182728OtherMEDICARE RR