=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528259330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIE A JOHNSON CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2007
-----------------------------------------------------
Last Update Date | 08/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 S COLUMBIA AVE
-----------------------------------------------------
City | CAMPBELLSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42718-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-465-6612
-----------------------------------------------------
Fax | 270-465-6612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 S COLUMBIA AVE
-----------------------------------------------------
City | CAMPBELLSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42718-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-465-6612
-----------------------------------------------------
Fax | 270-465-6612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JULIE A MICHAEL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 270-465-6612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3829
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------