| Organization Name: | CHAMPLAIN SPORTS MEDICINE |
| NPI Number: | 1518106491 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN RUSSELL JOHANSSON (OWNER/PHYSICIAN) |
| Mailing Address: | 67 Lincoln St Essex Junction |
| State: | VT US |
| Postal Code: | 054523235 |
| Phone Number: | 8028781003 |
| Fax Number: | 8028789961 |
| NPI Enumeration Date: | 02/17/2009 |
| NPI Last Update Date: | 02/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
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Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204C00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |