Provider Demographics
NPI:1831241108
Name:CHRISTIANSEN, TAMARA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN
Last Name:CHRISTIANSEN
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 1:250 W EISENHOWER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6948
Mailing Address - Country:US
Mailing Address - Phone:734-302-7000
Mailing Address - Fax:734-302-7001
Practice Address - Street 1:250 W EISENHOWER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6948
Practice Address - Country:US
Practice Address - Phone:734-302-7000
Practice Address - Fax:734-302-7001
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITC007291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN90410001OtherCOMMON PROVIDER CODE
MI950H112460OtherBCBSM
MI950H112460OtherBCBSM
MIU66045Medicare UPIN