Provider Demographics
NPI:1922095454
Name:CHRISTIANSEN, BRIAN NIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:NIEL
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6509
Mailing Address - Country:US
Mailing Address - Phone:865-482-1788
Mailing Address - Fax:865-482-1789
Practice Address - Street 1:170 W TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6509
Practice Address - Country:US
Practice Address - Phone:865-482-1788
Practice Address - Fax:865-482-1789
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN680213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3350013Medicaid
TN690000247OtherTAX IDENTIFICATION NUMBER