MEDICARE: P SCOTT JOHNSON D C INC

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	000000356189	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1619151222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P SCOTT JOHNSON D C INC

Provider Business Mailing Address
First Line	:	715 N MAIN ST
Second Line	:
City	:	BLUFFTON
State	:	IN
Zip	:	46714-1313
Country	:	US
Telephone Number	:	260-824-8183
Fax Number	:	260-824-8184

Provider Business Practice Location Address
First Line	:	715 N MAIN ST
Second Line	:
City	:	BLUFFTON
State	:	IN
Zip	:	46714-1313
Country	:	US
Telephone Number	:	260-824-8183
Fax Number	:	260-824-8184

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	DR. PERRY SCOTT JOHNSON
Credential	:	DC
Telephone Number	:	260-824-8183

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	12/21/2017

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