Provider Demographics
NPI:1699957563
Name:CHRISTENSEN, BRAD (DC)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
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 1:129 COMMERCIAL DR 5A
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4731
Mailing Address - Country:US
Mailing Address - Phone:630-553-7737
Mailing Address - Fax:630-553-7747
Practice Address - Street 1:302 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2511
Practice Address - Country:US
Practice Address - Phone:630-584-5800
Practice Address - Fax:630-584-6190
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3708012111N00000X
IL038-011158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK53518Medicare UPIN
WIU83614Medicare UPIN
ILIL3171004Medicare PIN