Provider Demographics
NPI:1194804112
Name:CHRISTENSEN, MICHAEL JON (DC, FIAMA)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DC, FIAMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N CLARK ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2573
Mailing Address - Country:US
Mailing Address - Phone:712-775-2777
Mailing Address - Fax:
Practice Address - Street 1:504 N CLARK ST STE 2
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2573
Practice Address - Country:US
Practice Address - Phone:712-775-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1123111N00000X
WI3223111N00000X
MN3369111N00000X
IA075712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91175903700Medicaid
NE91175903700Medicaid
NEU55462Medicare UPIN