MEDICARE: JOHNSON CHIROPRACTIC & ACUPUNCTURE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1070	SD
2	111N00000X	Chiropractor	602	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225450042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON CHIROPRACTIC & ACUPUNCTURE

Provider Business Mailing Address
First Line	:	4627 W HOMEFIELD DR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3511
Country	:	US
Telephone Number	:	160-533-6201
Fax Number	:	160-533-6024

Provider Business Practice Location Address
First Line	:	4627 W HOMEFIELD DR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3511
Country	:	US
Telephone Number	:	160-533-6201
Fax Number	:	160-533-6024

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRUCE EDWARD JOHNSON
Credential	:	D.C.
Telephone Number	:	16053362010

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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Directions to “JOHNSON CHIROPRACTIC & ACUPUNCTURE ” Practice Location

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