Provider Demographics
NPI:1215021746
Name:CHRISTIANSON, WILLIAM AMBROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:AMBROSE
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 1:1756 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5490
Mailing Address - Country:US
Mailing Address - Phone:319-399-1285
Mailing Address - Fax:319-399-1285
Practice Address - Street 1:1756 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-399-1285
Practice Address - Fax:319-399-1285
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0226324Medicaid
IA50154Medicare ID - Type Unspecified
IA0226324Medicaid