Bradley Jay Johnson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1104 Issued in MS

Practice address

10317 C Boney Ave.
D'Iberville, MS 39540-4836

Phone

(228) 392-9106

Fax

(228) 392-4664

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Specialty

Chiropractic

Education

Sherman College of Straight Chiropractic, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• D'Iberville Chiropractic Clinic, Inc.

  • Chiropractor
  • D'Iberville, MS
  • NPI 1568472215
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1962572941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10317 C BONEY AVE.",
            "city": "D'IBERVILLE",
            "state": "MS",
            "postal_code": "395404836",
            "telephone_number": "228-392-9106",
            "fax_number": "228-392-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10317 C BONEY AVE.",
            "city": "D'IBERVILLE",
            "state": "MS",
            "postal_code": "395404836",
            "telephone_number": "228-392-9106",
            "fax_number": "228-392-4664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRADLEY",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MS",
            "license": "1104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey J Ickler, M.D.
• Amy Jackson
• Jbchiro1 LLC (Advanced Chiropractic and Wellness)
• Jessica Jensen, LPC
• Donna Joachim, MS SPED ED
• Whitney Johnson
• Valerie Cascile Joiner, LCSW
• Sharon Jones
• Bernard Joseph Keenum, D.C.
• Gary Kerr II, REPT

• Chiropractor in D'Iberville, MS
• Providers in D'Iberville, MS by specialty
• Chiropractor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; 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.