Individual
DR. MARY J JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
23624 ST FRANCIS BLVD, SUITE 1, ST FRANCIS, MN 55070-0399
(763) 753-3126
(763) 753-2808
Mailing address
23624 ST. FRANCIS BLVD., STE #1, ST FRANCIS, MN 55070
(763) 753-3126
(763) 753-2808
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2663
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0125
HSM
—
01
—
231258
CCMI
—
01
—
4440078
MEDICA
—
01
—
4K008J0
BCBS CLINIC
—
01
—
4K009J0
BCBS INDIVIDUAL
—
05
—
817228500
—
MN
Enumeration date
01/22/2007
Last updated
07/10/2012
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