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Organization
CHAMPLAIN SPORTS MEDICINE PC
Active
Organization
CHAMPLAIN SPORTS MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RUSSELL JOHANSSON DO (OWNER/PHYSICIAN)
(802) 878-1003
Entity
Organization
Contact information
Practice address
67 LINCOLN ST, ESSEX JUNCTION, VT 05452-3235
(802) 878-1003
(802) 878-9966
Mailing address
67 LINCOLN ST, ESSEX JUNCTION, VT 05452-3235
(802) 878-1003
(802) 878-9966
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
0320000304
VT
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
NULL
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
Other
Enumeration date
02/17/2009
Last updated
06/13/2017
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