Provider Demographics
NPI:1023137825
Name:THEIN, CHRISTOPHER NICHOLAS (MS, ATC, EMT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:NICHOLAS
Last Name:THEIN
Suffix:
Gender:M
Credentials:MS, ATC, EMT
Other - Prefix:
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Mailing Address - Street 1:1315 CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3810
Mailing Address - Country:US
Mailing Address - Phone:763-546-1375
Mailing Address - Fax:
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:300
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:612-672-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN244106146N00000X
MN11722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer