Provider Demographics
NPI:1295863975
Name:CHRISTIANSON, ANTHONY TODD (DC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:TODD
Last Name:CHRISTIANSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:TODD
Other - Last Name:CHRISTIANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:S9661 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-9733
Mailing Address - Country:US
Mailing Address - Phone:608-544-4404
Mailing Address - Fax:
Practice Address - Street 1:150 E JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-588-2242
Practice Address - Fax:608-588-9384
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3115-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38882700Medicaid
WI70759Medicare ID - Type Unspecified