Provider Demographics
NPI:1194020644
Name:CHRISTIANSEN CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:CHRISTIANSEN CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ISELIN
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-276-2956
Mailing Address - Street 1:903 CALLE AMANECER STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6251
Mailing Address - Country:US
Mailing Address - Phone:949-276-2956
Mailing Address - Fax:949-276-2957
Practice Address - Street 1:903 CALLE AMANECER STE 230
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6251
Practice Address - Country:US
Practice Address - Phone:949-276-2956
Practice Address - Fax:949-276-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31644302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization