Provider Demographics
NPI:1306057013
Name:CHRISTENSEN, JEFFERY TATE (DC)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:TATE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1903
Mailing Address - Country:US
Mailing Address - Phone:515-967-7169
Mailing Address - Fax:515-967-8470
Practice Address - Street 1:507 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1903
Practice Address - Country:US
Practice Address - Phone:515-967-7169
Practice Address - Fax:515-967-8470
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06744OtherBCBS
IA06744OtherBCBS