MEDICARE: MATTHEW 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	7030	MN

General Provider Information

NPI Number	:	1659088508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JOHNSON DC

Provider Business Mailing Address
First Line	:	208 W JAMES ST
Second Line	:
City	:	PAYNESVILLE
State	:	MN
Zip	:	56362-1219
Country	:	US
Telephone Number	:	320-243-7412
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 W JAMES ST
Second Line	:
City	:	PAYNESVILLE
State	:	MN
Zip	:	56362-1219
Country	:	US
Telephone Number	:	329-243-7412
Fax Number	:

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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Directions to “ MATTHEW JOHNSON DC” Practice Location

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