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NPI Code Detail

MEDICARE: DR. MATTHEW MARK JOHNSON D.C.

MEDICARE: DR. MATTHEW MARK JOHNSON D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorB0989NV

General Provider Information

NPI Number : 1043375553
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW MARK JOHNSON D.C.
Provider Business Mailing Address
First Line : 1830 FAIRFIELD AVE
Second Line :
City : RENO
State : NV
Zip : 89509-3293
Country : US
Telephone Number : 775-359-0717
Fax Number : 775-359-1329
Provider Business Practice Location Address
First Line : 1950 E GREG ST
Second Line :
City : SPARKS
State : NV
Zip : 89431-6558
Country : US
Telephone Number : 775-359-0717
Fax Number : 775-359-1329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MATTHEW MARK JOHNSON D.C.” Practice Location

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