MEDICARE: DR. JARRETT DALE 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	1052	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

General Provider Information

NPI Number	:	1629030572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARRETT DALE JOHNSON DC

Provider Business Mailing Address
First Line	:	935 CEDAR LAKE RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39532-2128
Country	:	US
Telephone Number	:	228-424-4593
Fax Number	:	228-392-4001

Provider Business Practice Location Address
First Line	:	935 CEDAR LAKE RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39532-2128
Country	:	US
Telephone Number	:	228-424-4593
Fax Number	:	228-392-4001

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/30/2012

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