Healthcare Provider Details

I. General information

NPI: 1427059062
Provider Name (Legal Business Name): HOWARD E JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 FREEPORT AVE NW SUITE 5
ELK RIVER MN
55330-2632
US

IV. Provider business mailing address

804 FREEPORT AVE NW SUITE A
ELK RIVER MN
55330-2632
US

V. Phone/Fax

Practice location:
  • Phone: 763-441-3830
  • Fax: 763-441-4224
Mailing address:
  • Phone: 763-441-3830
  • Fax: 763-441-4224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1490
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: