Provider Demographics
NPI:1740594613
Name:BACH, CHRISTINE P (RD, LDN, CDE)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:P
Last Name:BACH
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E US HWY 74 BUS
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28040
Mailing Address - Country:US
Mailing Address - Phone:828-453-1730
Mailing Address - Fax:
Practice Address - Street 1:1027 EAST US HWY 74 BUS
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:NC
Practice Address - Zip Code:28040
Practice Address - Country:US
Practice Address - Phone:828-453-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ34085Medicare UPIN