Provider Demographics
NPI:1669402020
Name:CHRISTIANSON, BRYCE EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:EDWARD
Last Name:CHRISTIANSON
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 1:2140 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2916
Mailing Address - Country:US
Mailing Address - Phone:970-712-6059
Mailing Address - Fax:970-797-4842
Practice Address - Street 1:2140 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2916
Practice Address - Country:US
Practice Address - Phone:970-712-6059
Practice Address - Fax:970-797-4842
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV09635Medicare UPIN
COCO41383Medicare PIN