| NPI | 1164620613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH MICHAEL JOHNSON President 763-420-4242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MN 1844) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2020-08-22 |