Provider Demographics
NPI:1801093851
Name:DR JOHN P CHRISTENSEN P A
Entity type:Organization
Organization Name:DR JOHN P CHRISTENSEN P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC MD
Authorized Official - Phone:561-655-2225
Mailing Address - Street 1:542 N RIDGEWOOD AVE
Mailing Address - Street 2:WAGNER BUILDING
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2170
Mailing Address - Country:US
Mailing Address - Phone:386-258-7494
Mailing Address - Fax:386-253-0365
Practice Address - Street 1:542 N RIDGEWOOD AVE
Practice Address - Street 2:WAGNER BUILDING
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2170
Practice Address - Country:US
Practice Address - Phone:386-258-7494
Practice Address - Fax:386-253-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89833Medicare UPIN
FL89833Medicare PIN
FL89833YMedicare UPIN
FLK9897AMedicare ID - Type Unspecified
FL89833YMedicare PIN