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NPI Code Detail

MEDICARE: JENNIFER GWEN JOHNSON D.C.

MEDICARE: JENNIFER GWEN JOHNSON D.C.
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
1111N00000XChiropractor9178AZ
2111N00000XChiropractor1188MT
3111N00000XChiropractorCHI-CHI-LIC-1188MT

General Provider Information

NPI Number : 1386878676
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GWEN JOHNSON D.C.
Provider Business Mailing Address
First Line : 1117 W GALENA ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-1421
Country : US
Telephone Number : 406-565-3760
Fax Number :
Provider Business Practice Location Address
First Line : 31 W PARK ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-1713
Country : US
Telephone Number : 406-565-3760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2009
Last Update Date : 12/19/2022

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