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General NPI Number Information
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NPI Number | 1992826119
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Entity Type | Individual
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Provider Name | KRISTEN MARIE JOHANSEN D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 6852 W 111TH ST
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City | WORTH
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State | IL
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Zip | 60482-1823
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Country | US
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Telephone | 708-448-3818
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Fax | 708-448-3804
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Provider Business Mailing Address
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Address Line | 6852 W 111TH ST
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City | WORTH
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State | IL
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Zip | 60482-1823
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Country | US
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Telephone | 708-448-3818
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Fax | 708-448-3804
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-008775
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License Number State | IL
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