Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0401410989 | VA |
NPI | 1043421258 |
---|---|
Provider Name | Dr. Brad William Christenson |
First Address | Chesapeake, VA 23322-5365 |
Second Address | Chesapeake, VA 23322-5365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2007 |
Last Update Date | 08/07/2007 |