1295863975 NPI number — MR. ANTHONY TODD CHRISTIANSON D.C.

Table of content: MR. ANTHONY TODD CHRISTIANSON D.C. (NPI 1295863975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295863975 NPI number — MR. ANTHONY TODD CHRISTIANSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTIANSON
Provider First Name:
ANTHONY
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTIANSON
Provider Other First Name:
ANTHONY
Provider Other Middle Name:
TODD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295863975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
S9661 CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE DU SAC
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53578-9733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-544-4404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 E JEFFERSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING GREEN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-588-2242
Provider Business Practice Location Address Fax Number:
608-588-9384
Provider Enumeration Date:
03/02/2007

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:  3115-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38882700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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