MEDICARE: MIKAEL AXEL JOHNSON DC

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	038-010553	IL

General Provider Information

NPI Number	:	1982700373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAEL AXEL JOHNSON DC

Provider Business Mailing Address
First Line	:	5316 WEST ELM ST
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4029
Country	:	US
Telephone Number	:	815-324-4763
Fax Number	:	815-669-1047

Provider Business Practice Location Address
First Line	:	5316 WEST ELM ST
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4029
Country	:	US
Telephone Number	:	815-324-4763
Fax Number	:	815-669-1047

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/21/2022

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