# CHAMPLAIN SPORTS MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518106491
- **Authorized official:** DR. JOHN RUSSELL JOHANSSON DO (OWNER/PHYSICIAN)
- **Authorized official phone:** (802) 878-1003

## Contact information

- **Practice address:** 67 LINCOLN ST, ESSEX JUNCTION, VT 05452-3235
- **Practice address phone:** (802) 878-1003
- **Practice address fax:** (802) 878-9966
- **Mailing address:** 67 LINCOLN ST, ESSEX JUNCTION, VT 05452-3235
- **Mailing address phone:** (802) 878-1003
- **Mailing address fax:** (802) 878-9966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | 0320000304 | VT | Yes |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | NULL | — |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 02/17/2009
- **Last updated:** 06/13/2017