Healthcare Provider Details

I. General information

NPI: 1063510253
Provider Name (Legal Business Name): CHRISTOPHER LEE SORENSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

IV. Provider business mailing address

102 DOCTORS PARK
SAINT CLOUD MN
56303-1207
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-6422
  • Fax: 320-251-6423
Mailing address:
  • Phone: 320-251-6422
  • Fax: 320-251-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number001968
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: