Individual
BRUCE EDWARD JOHNSON
Active
Individual
BRUCE EDWARD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CHIROPRACTOR
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
602
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20860
SIOUX VALLEY HEALTH PLAN
SD
01
—
248015
MIDLAND
—
01
—
4994546
WELLMARK
SD
05
—
7600882
—
SD
Enumeration date
01/18/2006
Last updated
11/06/2007
Update your record
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