Healthcare Provider Details

I. General information

NPI: 1194642272
Provider Name (Legal Business Name): RYAN SCOTT JOHNSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

40 PEERLESS ST
BROCTON NY
14716-9701
US

V. Phone/Fax

Practice location:
  • Phone: 716-834-9200
  • Fax:
Mailing address:
  • Phone: 716-785-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number014083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: