Healthcare Provider Details

I. General information

NPI: 1043257504
Provider Name (Legal Business Name): CHADRON CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 MAIN ST
CHADRON NE
69337-2355
US

IV. Provider business mailing address

279 MAIN ST
CHADRON NE
69337-2355
US

V. Phone/Fax

Practice location:
  • Phone: 308-432-3518
  • Fax:
Mailing address:
  • Phone: 308-432-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1046
License Number StateNE

VIII. Authorized Official

Name: DR. SCOTT G. JOHNSON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 308-432-3518