Randy Robert Johnson, DC
Individual provider Active NPI Chiropractor · Glencoe, MN
NPI 1124180450 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124180450
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4635 (MN)
- Practice address
- 1706 East Tenth Street
Gauer Chiropractic Clinic
Glencoe, MN 55336 - Phone
- (320) 864-3196
- Fax
- (320) 864-3197
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gauer Chiropractic Clinic PA
Practice addresses (Care Compare)
1706 E 10TH St
Glencoe, MN 55336-2500
Phone (320) 864-3196
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050112000672 | MN | Practitioner - Chiropractic | 4789633173 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4635 | MN | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4635 | MN | Yes |
Addresses
Primary practice location
1706 East Tenth Street
Gauer Chiropractic Clinic
Glencoe, MN 55336
Mailing address
1706 East Tenth Street
Gauer Chiropractic Clinic
Glencoe, MN 55336
Phone (320) 864-3196
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30701128 | Other | PRIME WEST | |
| 869035 | Other | MN | AMERICAS PPO |
| 649104 | Other | MN | CHIROPRACTIC CARE OF MINN |
| 370K6J0 | Other | MN | BCBS |
Other providers in Glencoe, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.