Healthcare Provider Details

I. General information

NPI: 1336158278
Provider Name (Legal Business Name): MICHAEL NATHAN JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W INDIANTOWN RD SUITE 107
JUPITER FL
33458-6847
US

IV. Provider business mailing address

2318 BAY VILLAGE CT
WEST PALM BEACH FL
33410-2580
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-7707
  • Fax: 561-748-5502
Mailing address:
  • Phone: 561-694-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0003556
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: