MEDICARE: DR. RYAN M. JOHNSON D.C

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	1070	SD

General Provider Information

NPI Number	:	1770593964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN M. JOHNSON D.C

Provider Business Mailing Address
First Line	:	4507 W COTTAGE TRL
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-2193
Country	:	US
Telephone Number	:	605-271-0840
Fax Number	:

Provider Business Practice Location Address
First Line	:	4627 W HOMEFIELD DR
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-3511
Country	:	US
Telephone Number	:	605-336-2010
Fax Number	:	605-336-0249

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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