Provider Demographics
NPI:1184486227
Name:BIRD, CHRISTOPHER LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LAWRENCE
Last Name:BIRD
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 1:1351 N WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-8879
Mailing Address - Country:US
Mailing Address - Phone:641-895-7880
Mailing Address - Fax:
Practice Address - Street 1:509 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1180
Practice Address - Country:US
Practice Address - Phone:608-442-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6122-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor