1124008180 NPI number — MR. CHRISTOPHER S DAHL MPT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124008180 NPI number — MR. CHRISTOPHER S DAHL MPT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DAHL

Provider First Name:

CHRISTOPHER

Provider Middle Name:

S

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

MPT

Provider Gender Code:

M

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:

1124008180

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/20/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

15909 JACKSON CREEK PKWY STE 105

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MONUMENT

Provider Business Mailing Address State Name:

CO

Provider Business Mailing Address Postal Code:

80132-8693

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

719-481-0899

Provider Business Mailing Address Fax Number:

719-481-0897

Provider First Line Business Practice Location Address:

15909 JACKSON CREEK PKWY STE 105

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MONUMENT

Provider Business Practice Location Address State Name:

CO

Provider Business Practice Location Address Postal Code:

80132

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

719-481-0899

Provider Business Practice Location Address Fax Number:

719-481-0897

Provider Enumeration Date:

01/18/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  2305205880 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225100000X , with the licence number: 0006781 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0392740 . This is a "MEDICAID WELFARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 7509675 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: Y68346 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0392740 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 785950 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: Y68346 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: Y68346 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
• Identifier: 90547 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
• Identifier: Y69423 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".