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General NPI Number Information
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NPI Number | 1275845471
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Entity Type | Organization
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Legal Business Name | ROGERS CHIROPRACTIC PA
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 21370 JOHN MILLESS DR SUITE 215
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City | ROGERS
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State | MN
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Zip | 55374-9449
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Country | US
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Telephone | 763-428-9292
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Fax | 763-428-2018
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Provider Business Mailing Address
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Address Line | 21370 JOHN MILLESS DR SUITE 215
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City | ROGERS
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State | MN
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Zip | 55374-9449
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Country | US
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Telephone | 763-428-9292
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Fax | 763-428-2018
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JOHNSTON
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Credential | DC
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Telephone | 763-428-9292
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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 | 3472
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License Number State | MN
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