MEDICARE: DR. KENDAL E JOHNSON DC

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	0105928	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-05928	OTHER	KS	KANSAS STATE BOARD OF HEALING ARTS

General Provider Information

NPI Number	:	1255815254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENDAL E JOHNSON DC

Provider Business Mailing Address
First Line	:	20160 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-764-2271
Fax Number	:	913-764-2276

Provider Business Practice Location Address
First Line	:	20160 W 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-9131
Country	:	US
Telephone Number	:	913-764-2271
Fax Number	:	913-764-2276

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

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/17/2018

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