Provider Demographics
NPI:1679577373
Name:MATHISEN, CHRISTIAN H JR (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:H
Last Name:MATHISEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CRATER LAKE AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7482
Mailing Address - Country:US
Mailing Address - Phone:541-535-4111
Mailing Address - Fax:541-535-5051
Practice Address - Street 1:24 CRATER LAKE AVE
Practice Address - Street 2:STE 2
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7482
Practice Address - Country:US
Practice Address - Phone:541-535-4111
Practice Address - Fax:541-535-5051
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGFYHMedicare ID - Type Unspecified
ORU 46901Medicare UPIN