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General NPI Number Information
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NPI Number | 1558196626
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Entity Type | Organization
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Legal Business Name | JOHNSON CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 480 ST CLAIR ST
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City | MOORESVILLE
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State | IN
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Zip | 46158-1337
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Country | US
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Telephone | 317-584-3073
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 PAMELA DR
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City | PLAINFIELD
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State | IN
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Zip | 46168-9279
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Country | US
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Telephone | 317-507-2664
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JOHNSON
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Credential | DC
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Telephone | 317-507-2664
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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 |
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License Number State |
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