Provider Demographics
NPI:1154396901
Name:CHRISTENSEN, JEFFREY C (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 CHINOOK DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1376
Mailing Address - Country:US
Mailing Address - Phone:425-327-6603
Mailing Address - Fax:
Practice Address - Street 1:1823 37TH ST STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5089
Practice Address - Country:US
Practice Address - Phone:425-339-8888
Practice Address - Fax:425-258-6933
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000323213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000137680OtherUNITED HEALTHCARE
WA69529OtherWORKER'S COMPENSATION
WAR48544OtherREGENCE BLUE SHIELD
192445500OtherOWCP
WA4341580OtherAETNA U.S. HEALTHCARE
WA1086552Medicaid