Provider Demographics
NPI:1962529560
Name:MICKELSON, CHRISTINA MAE (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MAE
Last Name:MICKELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30840 N LAKES TRL
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9497
Mailing Address - Country:US
Mailing Address - Phone:651-257-9090
Mailing Address - Fax:651-257-9090
Practice Address - Street 1:30840 N LAKES TRL
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9497
Practice Address - Country:US
Practice Address - Phone:651-257-9090
Practice Address - Fax:651-257-9090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44-87206OtherMEDICA
MNV41199334276956OtherHEALTH PARTNERS
MN69B47MIOtherBCBS
MNV41199334276956OtherHEALTH PARTNERS