Provider Demographics
NPI:1013900372
Name:CHRISTENSEN, KIM D (DC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:D
Last Name:CHRISTENSEN
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 1:12503 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE 215A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4009
Mailing Address - Country:US
Mailing Address - Phone:360-448-6353
Mailing Address - Fax:240-371-7188
Practice Address - Street 1:12503 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 215A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4009
Practice Address - Country:US
Practice Address - Phone:360-448-6353
Practice Address - Fax:240-371-7188
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001479111N00000X, 111NS0005X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8931612OtherCRIME VICTIMS
OR022898Medicaid
WA253358OtherL&I
WA8378838Medicaid
P00231843OtherRR MEDICARE
T02552Medicare UPIN
WA8378838Medicaid