Provider Demographics
NPI:1194438333
Name:JOHNSON, EMMA (DC)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
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 1:301 SHELARD PKWY APT 125
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1022
Mailing Address - Country:US
Mailing Address - Phone:651-999-9124
Mailing Address - Fax:
Practice Address - Street 1:12455 RIDGEDALE DR STE 203
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1786
Practice Address - Country:US
Practice Address - Phone:952-314-7035
Practice Address - Fax:952-426-3414
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor