=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073781332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTERNATIVE HEALTH CENTERS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2008
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 6TH ST SE
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-4938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-882-0100
-----------------------------------------------------
Fax | 605-882-6911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 6TH ST SE
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57201-4938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-882-0100
-----------------------------------------------------
Fax | 605-882-6911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR / CEO
-----------------------------------------------------
Name | DR. SCOTT ANTHONY JOHNSON
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 605-882-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 845
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------