Provider Demographics
NPI:1427059062
Name:JOHNSON, HOWARD E (DC)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:E
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 1:804 FREEPORT AVE NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2632
Mailing Address - Country:US
Mailing Address - Phone:763-441-3830
Mailing Address - Fax:763-441-4224
Practice Address - Street 1:804 FREEPORT AVE NW
Practice Address - Street 2:SUITE 5
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2632
Practice Address - Country:US
Practice Address - Phone:763-441-3830
Practice Address - Fax:763-441-4224
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC07469Medicare ID - Type Unspecified