Healthcare Provider Details

I. General information

NPI: 1831492420
Provider Name (Legal Business Name): JOHNSON CHIROPRACTIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6635 NORTH ST
BENZONIA MI
49616-9765
US

IV. Provider business mailing address

6635 NORTH ST
BENZONIA MI
49616-9765
US

V. Phone/Fax

Practice location:
  • Phone: 231-882-5533
  • Fax: 231-882-1361
Mailing address:
  • Phone: 231-882-5533
  • Fax: 231-882-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2001007090
License Number StateMI

VIII. Authorized Official

Name: DR. JANINE JOHNSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 231-882-5533