Provider Demographics
NPI:1104438357
Name:JOHNSON, NICHOLAS ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NE 44TH ST APT 112
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4959
Mailing Address - Country:US
Mailing Address - Phone:406-890-1637
Mailing Address - Fax:
Practice Address - Street 1:1710 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2526
Practice Address - Country:US
Practice Address - Phone:515-964-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor