MEDICARE: EMILY JOHANNA 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
1	111N00000X	Chiropractor	086694	IA
2	111N00000X	Chiropractor	5271-12	WI

General Provider Information

NPI Number	:	1477086486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JOHANNA JOHNSON D.C.

Provider Business Mailing Address
First Line	:	16645 W GREENFIELD AVE STE D
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-1546
Country	:	US
Telephone Number	:	262-788-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	16645 W GREENFIELD AVE STE D
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-1546
Country	:	US
Telephone Number	:	262-788-5940
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/04/2019

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