Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | IL | |
N | 111NN1001X | Nutrition | IL |
NPI | 1326060351 |
---|---|
Provider Name | Susan Lynn Johnson |
First Address | Schaumburg, IL 60193-2083 |
Second Address | Schaumburg, IL 60193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1607417 | BLUE CROSS (01) | IL |