Healthcare Provider Details

I. General information

NPI: 1669593315
Provider Name (Legal Business Name): JOHNSON CHIROPRACTIC CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S BURR BLVD
KEWANEE IL
61443-2219
US

IV. Provider business mailing address

109 S BURR BLVD
KEWANEE IL
61443-2219
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-2885
  • Fax: 309-854-6410
Mailing address:
  • Phone: 309-852-2885
  • Fax: 309-854-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038004465
License Number StateIL

VIII. Authorized Official

Name: DR. JEFFREY W. JOHNSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 309-852-2885