Provider Demographics
NPI:1396197745
Name:CHRISTENSEN, KIMBERLY (MOM, DIPLOM, LAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:MOM, DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4509
Mailing Address - Country:US
Mailing Address - Phone:612-220-1211
Mailing Address - Fax:
Practice Address - Street 1:401 N 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1300
Practice Address - Country:US
Practice Address - Phone:612-787-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1793171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist