MEDICARE: DR. JOHN CHAD CHRISTIANSEN D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	176443-1202	UT

General Provider Information

NPI Number	:	1295764710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHAD CHRISTIANSEN D.C

Provider Business Mailing Address
First Line	:	1951 W 4700 S
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84118-1108
Country	:	US
Telephone Number	:	801-963-7711
Fax Number	:	801-969-8192

Provider Business Practice Location Address
First Line	:	1951 W 4700 S
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84118-1108
Country	:	US
Telephone Number	:	801-963-7711
Fax Number	:	801-969-8192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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