MEDICARE: JOHNSON NATURAL HEALTH CARE PA

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

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	64868JO	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1316074875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON NATURAL HEALTH CARE PA

Provider Business Mailing Address
First Line	:	1208 WASHINGTON AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3906
Country	:	US
Telephone Number	:	218-847-2809
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 WASHINGTON AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3906
Country	:	US
Telephone Number	:	218-847-2809
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAY WESLEY JOHNSON
Credential	:	DC
Telephone Number	:	218-847-2809

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	09/05/2007

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