Provider Demographics
NPI:1386945988
Name:JOHNSON, ABBY J (DC)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:J
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 1:1407 5TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-2080
Mailing Address - Country:US
Mailing Address - Phone:605-723-3434
Mailing Address - Fax:605-723-3436
Practice Address - Street 1:1407 5TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2080
Practice Address - Country:US
Practice Address - Phone:605-723-3434
Practice Address - Fax:605-723-3436
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010320111N00000X
CO6498111N00000X
SD1213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor