1013900372 NPI number — KIM D CHRISTENSEN DC

Table of content: KIM D CHRISTENSEN DC (NPI 1013900372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013900372 NPI number — KIM D CHRISTENSEN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTENSEN
Provider First Name:
KIM
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013900372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12503 SE MILL PLAIN BLVD
Provider Second Line Business Mailing Address:
SUITE 215A
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684-4009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-448-6353
Provider Business Mailing Address Fax Number:
240-371-7188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12503 SE MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 215A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-448-6353
Provider Business Practice Location Address Fax Number:
240-371-7188
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00001479 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NS0005X , with the licence number: CH00001479 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NR0400X , with the licence number: CH00001479 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8931612 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 022898 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 253358 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8378838 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00231843 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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