Provider Demographics
NPI:1891011987
Name:MIKKELSEN, CHRISTOPHER NOEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:NOEL
Last Name:MIKKELSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 E 57TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-4505
Mailing Address - Country:US
Mailing Address - Phone:605-830-2008
Mailing Address - Fax:605-271-7616
Practice Address - Street 1:2909 E 57TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-4505
Practice Address - Country:US
Practice Address - Phone:605-830-2008
Practice Address - Fax:605-271-7616
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor