Healthcare Provider Details

I. General information

NPI: 1932661154
Provider Name (Legal Business Name): DALLIN VAL CHRISTENSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N 500 E
LOGAN UT
84341-2455
US

IV. Provider business mailing address

5217 S STATE ST STE 200
MURRAY UT
84107-4812
US

V. Phone/Fax

Practice location:
  • Phone: 801-296-2113
  • Fax:
Mailing address:
  • Phone: 801-313-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13818928-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberO-1994
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number008762
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: