Individual provider Active NPI

Dustin Paul Johnson, DC

  • Chiropractor
  • Detroit Lakes, MN
National Provider Identifier
1770841405
Registry record updated May 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5660 Issued in MN
Practice address
213 State St W
Detroit Lakes, MN 56501-3005
Phone
(218) 847-4366
Fax
(218) 847-1838
NPI assigned
May 1, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5660 MN Primary

Addresses

Primary practice location

213 State St W
Detroit Lakes, MN 56501-3005

Mailing address

213 State St W
Detroit Lakes, MN 56501-3005
Phone (218) 847-4366

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140925002094 MN Practitioner - Chiropractic 8022264357 Reassigns benefits to 1 organization
Practice locations: Detroit Lakes, MN

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Detroit Lakes Chiropractic, PCGroup PAC ID 3072846195, 2 clinicians

Practice addresses (Care Compare)

213 State St W
Detroit Lakes, MN 56501-3005
Phone (218) 847-4366

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5660MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Detroit Lakes Chiropractic, PC Chiropractor CurrentSince Apr 1, 2019 Accepting new patients

Locations

213 State St W
Detroit Lakes, MN 56501
Phone (218) 847-4366

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335830400000",
    "number": "1770841405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 STATE ST W",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013005",
            "telephone_number": "218-847-4366",
            "fax_number": "218-847-1838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 STATE ST W",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013005",
            "telephone_number": "218-847-4366",
            "fax_number": "218-847-1838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DUSTIN",
        "middle_name": "PAUL",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.