Provider Demographics
NPI:1427213909
Name:CHRISTIANSON, KATHY (DOM, LAC, LMT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:DOM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DAIRY RD STE E-412
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2312
Mailing Address - Country:US
Mailing Address - Phone:575-613-0321
Mailing Address - Fax:
Practice Address - Street 1:82A COUNTY ROAD 122
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3187
Practice Address - Country:US
Practice Address - Phone:505-753-7576
Practice Address - Fax:505-753-7676
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist