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General NPI Number Information
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NPI Number | 1316927288
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Entity Type | Individual
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Provider Name | BRUCE EDWARD JOHNSON CHIROPRACTOR
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 4627 W HOMEFIELD DR
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City | SIOUX FALLS
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State | SD
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Zip | 57106-3511
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Country | US
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Telephone | 605-336-2010
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Fax | 605-336-0249
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Provider Business Mailing Address
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Address Line | 4627 W HOMEFIELD DR
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City | SIOUX FALLS
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State | SD
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Zip | 57106-3511
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Country | US
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Telephone | 605-336-2010
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Fax | 605-336-0249
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 602
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License Number State | SD
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