| Johnson Chiropractic, Sc | |
|
310 Susan Dr Suite 2 Normal IL 61761-6246 | |
| (309) 808-1123 | |
| (309) 808-1516 |
| Full Name | Johnson Chiropractic, Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 310 Susan Dr, Normal, Illinois |
| Authorized Official Name and Position | Joshua L Johnson (OWNER/CHIROPRACTOR) |
| Authorized Official Contact | 3098081123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Johnson Chiropractic, Sc 310 Susan Dr Suite 2 Normal IL 61761-6246 Ph: (309) 808-1123 | Johnson Chiropractic, Sc 310 Susan Dr Suite 2 Normal IL 61761-6246 Ph: (309) 808-1123 |
| NPI Number | 1275974545 |
|---|---|
| Provider Enumeration Date | 07/15/2013 |
| Last Update Date | 07/15/2013 |
| Medicare PECOS PAC ID | 7113288374 |
|---|---|
| Medicare Enrollment ID | O20180302002154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275974545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 038.011514 (Illinois) | Primary |
| Provider Name | Joshua L Johnson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1619289261 PECOS PAC ID: 7416123468 Enrollment ID: I20111222000255 |
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