MEDICARE: SCOTT ALLEN 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	0876	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CP43105	OTHER	MS	COMPLETE HEALTH
3	5219536	OTHER	MS	AETNA NETWORK
4	869651	OTHER	MS	FIRST HEALTH NETWORK
5	3203A	OTHER	LA	BC/BS OF LA
6	730-69128	OTHER	AL	BC/BS OF AL

General Provider Information

NPI Number	:	1255392825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ALLEN JOHNSON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 5801
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-5801
Country	:	US
Telephone Number	:	228-826-2724
Fax Number	:	228-826-1669

Provider Business Practice Location Address
First Line	:	5600 C L DEES DR
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-8346
Country	:	US
Telephone Number	:	228-826-2724
Fax Number	:	228-826-1669

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	08/07/2008

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Directions to “ SCOTT ALLEN JOHNSON D.C.” Practice Location

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