Provider Demographics
NPI:1285857953
Name:WEISENBORN, CHRISTOPHER JAY (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAY
Last Name:WEISENBORN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7904 NE 6TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8150
Mailing Address - Country:US
Mailing Address - Phone:360-910-7183
Mailing Address - Fax:
Practice Address - Street 1:7904 NE 6TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8150
Practice Address - Country:US
Practice Address - Phone:360-910-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist