MEDICARE: STEPHEN D 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	CH5721	FL

General Provider Information

NPI Number	:	1710983747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN D JOHNSON DC

Provider Business Mailing Address
First Line	:	2390 GRIFFIN RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-6760
Country	:	US
Telephone Number	:	863-859-0335
Fax Number	:	863-859-0501

Provider Business Practice Location Address
First Line	:	2390 GRIFFIN RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-6760
Country	:	US
Telephone Number	:	863-859-0335
Fax Number	:	863-859-0501

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	09/26/2011

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