Healthcare Provider Details

I. General information

NPI: 1750299079
Provider Name (Legal Business Name): JOHNSON SPINE AND JOINT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 GERVAIS AVE STE 13
MAPLEWOOD MN
55109-2191
US

IV. Provider business mailing address

1636 GERVAIS AVE STE 13
MAPLEWOOD MN
55109-2191
US

V. Phone/Fax

Practice location:
  • Phone: 651-615-6005
  • Fax:
Mailing address:
  • Phone: 651-615-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSY CHARLES-JAMES JOHNSON
Title or Position: OWNER
Credential: DC
Phone: 651-615-6005