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General NPI Number Information
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NPI Number | 1255392825
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Entity Type | Individual
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Provider Name | SCOTT ALLEN JOHNSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 5600 C L DEES DR
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City | VANCLEAVE
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State | MS
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Zip | 39565-8346
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Country | US
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Telephone | 228-826-2724
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Fax | 228-826-1669
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Provider Business Mailing Address
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Address Line | PO BOX 5801
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City | VANCLEAVE
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State | MS
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Zip | 39565-5801
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Country | US
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Telephone | 228-826-2724
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Fax | 228-826-1669
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0876
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License Number State | MS
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