1891775276 NPI number — DR. DAVID CHRISTENSEN OD

Table of content: DR. DAVID CHRISTENSEN OD (NPI 1891775276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891775276 NPI number — DR. DAVID CHRISTENSEN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTENSEN
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1891775276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 ROBINS SQUARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROBINS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-377-2222
Provider Business Mailing Address Fax Number:
319-294-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 EAST POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-377-2222
Provider Business Practice Location Address Fax Number:
319-377-2967
Provider Enumeration Date:
01/20/2006

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: 152W00000X , with the licence number:  02182 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21637 . This is a "BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 28986 . This is a "BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 410043671 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0461921 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7236139 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21634 . This is a "BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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