Healthcare Provider Details

I. General information

NPI: 1831947134
Provider Name (Legal Business Name): CHRISTIAN JOHN HENRIKSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314-1548
US

IV. Provider business mailing address

1801 HICKMAN RD
DES MOINES IA
50314-1548
US

V. Phone/Fax

Practice location:
  • Phone: 515-228-2200
  • Fax:
Mailing address:
  • Phone: 515-282-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-57189
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: