Individual provider · NPI-1
Andrea G Johnson, CSPOMM DO MB
Neuromusculoskeletal Medicine & OMM · Okemos, MI
NPI number1679568174
StatusActive
Last updated in NPPESJun 28, 2022
Details
- NPI
- 1679568174
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Andrea G Johnson
- Credential
- CSPOMM DO MB
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 12, 2005
- Certification date
- Jun 28, 2022
- Last updated
- Jun 28, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 204D00000X | Neuromusculoskeletal Medicine & OMM | 5101009343 | MI | Yes |
| 208D00000X | General Practice | 5101009343 | MI |
Practice location
2501 Jolly RdSuite 120
Okemos, MI 48864-3676
Phone 517-381-0299 · Fax 517-381-9950
Mailing address
1150 E Sherman Blvd Ste 2400Muskegon, MI 49444-1886
Phone 231-672-6336 · Fax 231-672-6335
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