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General NPI Number Information
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NPI Number | 1871881052
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Entity Type | Individual
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Provider Name | CHAD J JOHNSON DO
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Gender | Male
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1411 FALLS AVE E STE 1301
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City | TWIN FALLS
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State | ID
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Zip | 83301-3467
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Country | US
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Telephone | 208-735-8585
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Fax | 208-933-2001
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Provider Business Mailing Address
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Address Line | 1411 FALLS AVE E STE 1301
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City | TWIN FALLS
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State | ID
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Zip | 83301-3467
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Country | US
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Telephone | 208-735-8585
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Fax | 208-933-2001
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 8974078-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | O-0694
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License Number State | ID
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