Provider Demographics
NPI:1285711663
Name:JOHNSON SPINAL CARE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:JOHNSON SPINAL CARE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-432-3333
Mailing Address - Street 1:14859 ENERGY WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5763
Mailing Address - Country:US
Mailing Address - Phone:952-432-3333
Mailing Address - Fax:952-432-4444
Practice Address - Street 1:14859 ENERGY WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5763
Practice Address - Country:US
Practice Address - Phone:952-432-3333
Practice Address - Fax:952-432-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4526179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03135Medicare ID - Type UnspecifiedGROUP NUMBER FOR CLINIC