Provider Demographics
NPI:1356512560
Name:CHRISTENSEN, JEREMY CADE (DPM)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:CADE
Last Name:CHRISTENSEN
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 1:3740 DACORO LN
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2503
Mailing Address - Country:US
Mailing Address - Phone:303-660-4115
Mailing Address - Fax:
Practice Address - Street 1:3740 DACORO LN
Practice Address - Street 2:SUITE 105
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2503
Practice Address - Country:US
Practice Address - Phone:303-660-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO678213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80305875Medicaid
COCOB4052Medicare UPIN
COCO400053Medicare UPIN
COCOB4052Medicare PIN
COCO400053Medicare PIN