NPIMap

Organization Active NPI

Johnson Chiropractic Clinic of Maple Grove, Inc

  • Sports Physician Chiropractor
  • Maple Grove, MN
National Provider Identifier
1164620613
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
1844 Issued in MN
Legal business name
JOHNSON CHIROPRACTIC CLINIC OF MAPLE GROVE, INC
Practice address
13700 83Rd Way N Ste 200
Maple Grove, MN 55369-7015
Phone
(763) 420-4242
NPI assigned
Jul 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Keith Michael Johnson, DCNPI 1568553147
Title
President
Phone
(763) 420-4242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NS0005X 1844 MN Primary

Addresses

Primary practice location

13700 83Rd Way N Ste 200
Maple Grove, MN 55369-7015

Mailing address

13700 83Rd Way N Ste 200
Maple Grove, MN 55369-7015
Phone (763) 420-4242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071024000036 MN Part B Supplier - Clinic/Group Practice 9436245305 Receives reassigned benefits from 2 practitioners
Practice locations: Maple Grove, MN

National Provider Directory

National Provider Directory

Locations

13700 83rd Way N
Ste 200
Maple Grove, MN 55369
Phone (763) 420-4242

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164620613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13700 83RD WAY N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697015",
            "telephone_number": "763-420-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13700 83RD WAY N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697015",
            "telephone_number": "763-420-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON CHIROPRACTIC CLINIC OF MAPLE GROVE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-420-4242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "MN",
            "license": "1844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.