Provider Demographics
NPI:1134325657
Name:JOHNSEN, CHRISTOPHER E (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:E
Last Name:JOHNSEN
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 1:82 MAIN STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-737-7787
Mailing Address - Fax:413-737-7789
Practice Address - Street 1:82 MAIN STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-737-7787
Practice Address - Fax:413-737-7789
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36378OtherBLUE CROSS BLUE SHIELD
MA1612611Medicaid
MAY45018Medicare ID - Type Unspecified