Provider Demographics
NPI:1427082502
Name:JOHNSON, KAIJA MICHON (DC)
Entity type:Individual
Prefix:DR
First Name:KAIJA
Middle Name:MICHON
Last Name:JOHNSON
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2535
Mailing Address - Country:US
Mailing Address - Phone:320-763-6533
Mailing Address - Fax:320-763-6534
Practice Address - Street 1:1413 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2535
Practice Address - Country:US
Practice Address - Phone:320-763-6533
Practice Address - Fax:320-763-6534
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN4390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN89465660Medicaid