Provider Demographics
NPI:1104143007
Name:JOHNSON, KRISTIN L (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3556
Mailing Address - Country:US
Mailing Address - Phone:763-537-8070
Mailing Address - Fax:
Practice Address - Street 1:4900 HIGHWAY 169 N STE 324
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4046
Practice Address - Country:US
Practice Address - Phone:763-537-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor