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General NPI Number Information
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NPI Number | 1558547026
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Entity Type | Organization
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Legal Business Name | JOHNSON CHIROPRACTIC HEALTH SERVICE
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 195 14TH ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-5976
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Country | US
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Telephone | 920-921-4910
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Fax | 920-921-8645
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Provider Business Mailing Address
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Address Line | 195 14TH ST P.O.BOX 1451
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City | FOND DU LAC
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State | WI
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Zip | 54935-5976
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Country | US
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Telephone | 920-921-4910
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Fax | 920-921-8645
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY NEIL JOHNSON
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Credential | D.C.
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Telephone | 920-921-4910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1431
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License Number State | WI
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