Provider Demographics
NPI:1801338504
Name:CHRISTIANSON, AMY NGUYEN (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NGUYEN
Last Name:CHRISTIANSON
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 1:6560 45TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-3324
Mailing Address - Country:US
Mailing Address - Phone:701-541-1738
Mailing Address - Fax:
Practice Address - Street 1:5675 26TH AVE S STE 140
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8975
Practice Address - Country:US
Practice Address - Phone:701-541-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1472633Medicaid