Provider Demographics
NPI:1639322530
Name:PALLANSCH, CHRISTINE L
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:PALLANSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 2ND ST S
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1662
Mailing Address - Country:US
Mailing Address - Phone:320-230-8080
Mailing Address - Fax:
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE 121
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1662
Practice Address - Country:US
Practice Address - Phone:320-230-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist