Provider Demographics
NPI:1760115232
Name:ADAMS, CHRISTIAN DANE
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DANE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 UNIVERSITY AVE APT 34
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726-5817
Mailing Address - Country:US
Mailing Address - Phone:701-866-7050
Mailing Address - Fax:
Practice Address - Street 1:2308 UNIVERSITY AVE APT 34
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53726-5817
Practice Address - Country:US
Practice Address - Phone:701-866-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program