=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679026033
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID B JOHNSON D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2016
-----------------------------------------------------
Last Update Date | 12/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6600 FRANCE AVE S STE 206
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-926-7515
-----------------------------------------------------
Fax | 952-952-8155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 EGAN DR STE 100
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55378-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-746-4162
-----------------------------------------------------
Fax | 952-808-3112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6252
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------