Chad Allan Johnson, DC
Individual provider Active NPI Chiropractor · Augusta, WI
NPI 1861554792 · NPPES record last updated Dec 8, 2009
Key facts
- NPI
- 1861554792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3790012 (WI)
- Practice address
- 112 E Lincoln St
Augusta, WI 54722-9234 - Phone
- (715) 286-5515
- Fax
- (715) 286-4471
- NPI assigned
- Dec 15, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090409000383 | WI | Practitioner - Chiropractic | 2062569916 | Practice locations: Augusta, WI |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3790012 | WI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3790012 | WI | Yes |
Addresses
Primary practice location
112 E Lincoln St
Augusta, WI 54722-9234
Mailing address
112 E Lincoln St
Augusta, WI 54722-9234
Phone (715) 286-5515
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38934900 | Medicaid | WI |
Other providers in Augusta, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2009. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.