MEDICARE: DR. GARY DAVID JOHNSON D.C., DCBCN

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	111NN1001X	Nutrition Chiropractor	1651	MN

General Provider Information

NPI Number	:	1285931923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DAVID JOHNSON D.C., DCBCN

Provider Business Mailing Address
First Line	:	413 W. MORGAN STREET
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811
Country	:	US
Telephone Number	:	218-343-3412
Fax Number	:	218-724-7826

Provider Business Practice Location Address
First Line	:	413 W MORGAN ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4432
Country	:	US
Telephone Number	:	218-343-3412
Fax Number	:	218-724-7826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	09/18/2013

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