1871639120 NPI number — PROF. MARJORIE ROSENGREN JOHNSON D.C., PH.D.

Table of content: DR. MINAXI I DESAI M.D. (NPI 1649385766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871639120 NPI number — PROF. MARJORIE ROSENGREN JOHNSON D.C., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
MARJORIE
Provider Middle Name:
ROSENGREN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
D.C., PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNUTH (MAIDEN NAME)
Provider Other First Name:
MARJORIE
Provider Other Middle Name:
ROSENGREN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871639120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28012 230TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LECLAIRE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52753-9177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-289-3729
Provider Business Mailing Address Fax Number:
563-884-5897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BRADY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52803-5214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-884-5744
Provider Business Practice Location Address Fax Number:
563-884-5897
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  03033 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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