Provider Demographics
NPI:1710371190
Name:WALLEN, CHRISTINE (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WALLEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:R
Other - Last Name:WALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:410 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-7604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3221 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1453
Practice Address - Country:US
Practice Address - Phone:319-396-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor