MEDICARE: DR. BRUCE ROB 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
1	111N00000X	Chiropractor	2682	SC

General Provider Information

NPI Number	:	1063631497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ROB JOHNSON D.C.

Provider Business Mailing Address
First Line	:	4101 MAIN STREET
Second Line	:	SUITE A
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926
Country	:	US
Telephone Number	:	843-342-3606
Fax Number	:	843-342-3608

Provider Business Practice Location Address
First Line	:	4101 MAIN ST
Second Line	:	SUITE A
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-4608
Country	:	US
Telephone Number	:	843-342-3606
Fax Number	:	843-342-3608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	05/26/2010

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