Provider Demographics
NPI:1295094217
Name:CHRISTENSEN, JAMES KENDALL (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENDALL
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:98 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1758
Mailing Address - Country:US
Mailing Address - Phone:208-535-3626
Mailing Address - Fax:208-523-5343
Practice Address - Street 1:2375 E SUNNYSIDE RD
Practice Address - Street 2:STE F
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8280
Practice Address - Country:US
Practice Address - Phone:208-523-5343
Practice Address - Fax:208-523-5343
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDO-0986207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine