Provider Demographics
NPI:1619002573
Name:CHRISTENSEN CHIROPRACTIC, SC
Entity Type:Organization
Organization Name:CHRISTENSEN CHIROPRACTIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-873-9003
Mailing Address - Street 1:1200 NYGAARD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-5491
Mailing Address - Country:US
Mailing Address - Phone:608-873-9003
Mailing Address - Fax:608-873-9007
Practice Address - Street 1:1200 NYGAARD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-5491
Practice Address - Country:US
Practice Address - Phone:608-873-9003
Practice Address - Fax:608-873-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38932500Medicaid
WI38932500Medicaid
WIU74409Medicare UPIN