Healthcare Provider Details

I. General information

NPI: 1003911108
Provider Name (Legal Business Name): KIMBERLY ANN JOHNSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 3RD AVE E
SHAKOPEE MN
55379-1679
US

IV. Provider business mailing address

2516 FRIENDSHIP LN
BURNSVILLE MN
55337-4247
US

V. Phone/Fax

Practice location:
  • Phone: 952-445-7890
  • Fax: 953-445-7893
Mailing address:
  • Phone: 952-435-6557
  • Fax: 952-445-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003655
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: