Healthcare Provider Details

I. General information

NPI: 1043363880
Provider Name (Legal Business Name): JANINE FELICE-JOHNSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6635 NORTH ST
BENZONIA MI
49616
US

IV. Provider business mailing address

6635 NORTH ST
BENZONIA MI
49616
US

V. Phone/Fax

Practice location:
  • Phone: 231-882-5533
  • Fax: 231-882-7105
Mailing address:
  • Phone: 231-882-5533
  • Fax: 231-882-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1007090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: