Provider Demographics
NPI:1114991502
Name:CHRISTIANSON, WAYNE A (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:CHRISTIANSON
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 1:9749 KAHL RD
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-9516
Mailing Address - Country:US
Mailing Address - Phone:715-983-5500
Mailing Address - Fax:
Practice Address - Street 1:40195 WINSAND DRIVE
Practice Address - Street 2:SUITE 4 BOX 425
Practice Address - City:PIGEON FALLS
Practice Address - State:WI
Practice Address - Zip Code:54760-0425
Practice Address - Country:US
Practice Address - Phone:715-983-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT61662Medicare UPIN
WI35806 0002Medicare ID - Type UnspecifiedMEDICARE