Provider Demographics
NPI:1780895409
Name:CHRISTENSEN, SHERRY JEANINE (DC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:JEANINE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-2015
Mailing Address - Country:US
Mailing Address - Phone:515-777-1362
Mailing Address - Fax:515-777-1362
Practice Address - Street 1:5045 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-2015
Practice Address - Country:US
Practice Address - Phone:515-777-1362
Practice Address - Fax:515-777-1362
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06711OtherBCBS
IA06711OtherBCBS
IAI8665Medicare ID - Type Unspecified