Provider Demographics
NPI:1295040012
Name:NIELSEN, KRISTOPHER (CO)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 NE BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1425
Mailing Address - Country:US
Mailing Address - Phone:503-287-0459
Mailing Address - Fax:503-281-9252
Practice Address - Street 1:1627 NE BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1425
Practice Address - Country:US
Practice Address - Phone:503-287-0459
Practice Address - Fax:503-281-9252
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist