Provider Demographics
NPI:1861554792
Name:JOHNSON, CHAD ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALLAN
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 1:112 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WI
Mailing Address - Zip Code:54722-9234
Mailing Address - Country:US
Mailing Address - Phone:715-286-5515
Mailing Address - Fax:715-286-4471
Practice Address - Street 1:112 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-9234
Practice Address - Country:US
Practice Address - Phone:715-286-5515
Practice Address - Fax:715-286-4471
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3790012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38934900Medicaid
WI38934900Medicaid