Provider Demographics
NPI:1003015991
Name:CHRISTENSEN,CHRISTENSEN & FREESEMAN,PC
Entity Type:Organization
Organization Name:CHRISTENSEN,CHRISTENSEN & FREESEMAN,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-234-4486
Mailing Address - Street 1:847 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2141
Mailing Address - Country:US
Mailing Address - Phone:319-234-4486
Mailing Address - Fax:319-232-4913
Practice Address - Street 1:847 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2141
Practice Address - Country:US
Practice Address - Phone:319-234-4486
Practice Address - Fax:319-232-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0007948Medicaid
PA000971058OtherUNITED CONCORDIA