Provider Demographics
NPI:1043363880
Name:FELICE-JOHNSON, JANINE (DC)
Entity type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:FELICE-JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616
Mailing Address - Country:US
Mailing Address - Phone:231-882-5533
Mailing Address - Fax:231-882-7105
Practice Address - Street 1:6635 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616
Practice Address - Country:US
Practice Address - Phone:231-882-5533
Practice Address - Fax:231-882-7105
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1007090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950A010070OtherBCBS
350055226OtherRAIL ROAD MEDICARE
350055226OtherRAIL ROAD MEDICARE
950A010070OtherBCBS