Healthcare Provider Details

I. General information

NPI: 1902874274
Provider Name (Legal Business Name): SCOTT GENE JOHNSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
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: 308-432-8933
Mailing address:
  • Phone: 308-432-3518
  • Fax: 308-432-8933

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:
Title or Position:
Credential:
Phone: