Provider Demographics
NPI:1790060895
Name:CHRISTIANSON, JOHN A V (ND)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:CHRISTIANSON
Suffix:V
Gender:M
Credentials:ND
Other - Prefix:
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Mailing Address - Street 1:550 W DATE ST APT 712
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2764
Mailing Address - Country:US
Mailing Address - Phone:612-532-7895
Mailing Address - Fax:619-860-1272
Practice Address - Street 1:501 W BROADWAY STE A266
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3536
Practice Address - Country:US
Practice Address - Phone:619-241-4452
Practice Address - Fax:619-860-1272
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAND818175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA818OtherNATUROPATHIC DOCTOR