Provider Demographics
NPI:1629070453
Name:WAKEFIELD, CHRISTINE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W 57TH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3145
Mailing Address - Country:US
Mailing Address - Phone:605-274-1900
Mailing Address - Fax:605-782-9011
Practice Address - Street 1:3220 W 57TH ST
Practice Address - Street 2:STE 103
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3145
Practice Address - Country:US
Practice Address - Phone:605-274-1900
Practice Address - Fax:605-275-0625
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7600382Medicaid
SD7600382Medicaid
SDU71129Medicare UPIN