Provider Demographics
NPI:1073591640
Name:CHRISTENSEN, CASEY DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:DALE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11213 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-3111
Mailing Address - Country:US
Mailing Address - Phone:562-947-5578
Mailing Address - Fax:562-943-3115
Practice Address - Street 1:11213 1ST AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-3111
Practice Address - Country:US
Practice Address - Phone:562-947-5578
Practice Address - Fax:562-943-3115
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18762Medicare ID - Type Unspecified
CAU35428Medicare UPIN