MEDICARE: DR. DANIEL D CHRISTENSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	268288-1205	UT

General Provider Information

NPI Number	:	1063460111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL D CHRISTENSEN M.D.

Provider Business Mailing Address
First Line	:	501 CHIPETA WAY
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84108-1222
Country	:	US
Telephone Number	:	801-587-3122
Fax Number	:	801-582-8471

Provider Business Practice Location Address
First Line	:	501 CHIPETA WAY
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84108-1222
Country	:	US
Telephone Number	:	801-587-3122
Fax Number	:	801-582-8471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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