Provider Demographics
NPI:1184631830
Name:CHRISTIANSEN, COREY JAMES (DC)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:JAMES
Last Name:CHRISTIANSEN
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 1:213 W COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9327
Mailing Address - Country:US
Mailing Address - Phone:608-839-5787
Mailing Address - Fax:608-839-5853
Practice Address - Street 1:213 W COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9327
Practice Address - Country:US
Practice Address - Phone:608-839-5787
Practice Address - Fax:608-839-5853
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3224012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55527Medicare UPIN
70946Medicare ID - Type Unspecified