Provider Demographics
NPI:1215077425
Name:JOHNSON CHIROPRACTIC HEALTH CENTER PLLC
Entity type:Organization
Organization Name:JOHNSON CHIROPRACTIC HEALTH CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-321-5243
Mailing Address - Street 1:5021 W ST JOE HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4027
Mailing Address - Country:US
Mailing Address - Phone:517-321-5243
Mailing Address - Fax:517-321-8018
Practice Address - Street 1:5021 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4027
Practice Address - Country:US
Practice Address - Phone:517-321-5243
Practice Address - Fax:517-321-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU32647Medicare ID - Type UnspecifiedMEDICARE