Healthcare Provider Details

I. General information

NPI: 1891980231
Provider Name (Legal Business Name): JOHNS CHIROPRACTIC CLINIC, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 W BARNARD AVE
GREENFIELD WI
53220-4223
US

IV. Provider business mailing address

7701 W BARNARD AVE
GREENFIELD WI
53220-4223
US

V. Phone/Fax

Practice location:
  • Phone: 414-321-2273
  • Fax:
Mailing address:
  • Phone: 414-321-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number2547-012
License Number StateWI

VIII. Authorized Official

Name: CARMEN MARIE JOHNS
Title or Position: OFFICE MANAGER
Credential:
Phone: 414-321-2273