Individual
MARY JO JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1305 W 96TH ST, SUITE C, INDIANAPOLIS, IN 46260-1192
(317) 580-9867
Mailing address
1305 W 96TH ST, SUITE C, INDIANAPOLIS, IN 46260-1192
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001438A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000189532
BCBS
IN
05
—
100216510A
—
IN
01
—
645867
ACN
IN
Enumeration date
08/19/2005
Last updated
08/08/2023
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