Provider Demographics
NPI:1144844598
Name:JOHNSON, CHRISTIAN ALLEN (DC)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ALLEN
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 1:5697 GREEN CIRCLE DR APT 309
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18202 MINNETONKA BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4136
Practice Address - Country:US
Practice Address - Phone:952-956-6444
Practice Address - Fax:952-808-3112
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor