Healthcare Provider Details

I. General information

NPI: 1881675106
Provider Name (Legal Business Name): SCOTT MICHAEL JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 N MILLER RD SUITE 102
SCOTTSDALE AZ
85251-3697
US

IV. Provider business mailing address

7343 E CAMELBACK RD SUITE B
SCOTTSDALE AZ
85251-3442
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-0008
  • Fax: 480-306-7238
Mailing address:
  • Phone: 480-306-7227
  • Fax: 480-306-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: