1558547026 NPI number — JOHNSON CHIROPRACTIC HEALTH SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558547026 NPI number — JOHNSON CHIROPRACTIC HEALTH SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON CHIROPRACTIC HEALTH SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558547026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 14TH ST
Provider Second Line Business Mailing Address:
P.O.BOX 1451
Provider Business Mailing Address City Name:
FOND DU LAC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54935-5976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-921-4910
Provider Business Mailing Address Fax Number:
920-921-8645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOND DU LAC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54935-5976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-921-4910
Provider Business Practice Location Address Fax Number:
920-921-8645
Provider Enumeration Date:
01/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
NEIL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
920-921-4910

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  1431 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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