=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184748709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY MARTIN CHRISTENSEN DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 04/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1827 TEXOMA PKWY 100
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-892-5670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1827 TEXOMA PKWY 100
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75090-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-241-4030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9737
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------