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General NPI Number Information
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NPI Number | 1659434199
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Entity Type | Individual
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Provider Name | MATTHEW CHRISTIANSEN
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15010 W GREENFIELD AVE 100
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City | BROOKFIELD
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State | WI
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Zip | 53005
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Country | US
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Telephone | 262-754-5500
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Fax | 262-754-5501
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Provider Business Mailing Address
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Address Line | 1034 OXFORD RD
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City | WAUKESHA
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State | WI
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Zip | 53186-6446
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3889-012
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License Number State | WI
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