Provider Demographics
NPI:1366482135
Name:CHILDERS, CHRISTI (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6020
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-6020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 E MICHIGAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1506
Practice Address - Country:US
Practice Address - Phone:605-559-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G79383Medicare UPIN
SDS111418Medicare PIN
SDS40233Medicare PIN