Provider Demographics
NPI:1902874274
Name:JOHNSON, SCOTT GENE (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:GENE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2355
Mailing Address - Country:US
Mailing Address - Phone:308-432-3518
Mailing Address - Fax:308-432-8933
Practice Address - Street 1:279 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2355
Practice Address - Country:US
Practice Address - Phone:308-432-3518
Practice Address - Fax:308-432-8933
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1046111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
350041886OtherRR MEDICARE PTAN
NE10025769400OtherMEDICAID GROUP
22531OtherMIDLANDS CHOICE
CN3439OtherRR MEDICARE
NE9742OtherBCBS
NE9742OtherBCBS
22531OtherMIDLANDS CHOICE
U29735Medicare UPIN