Provider Demographics
NPI:1760115232
Name:ADAMS, CHRISTIAN DANE
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DANE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 GREENBRIER RD APT 222
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3415
Mailing Address - Country:US
Mailing Address - Phone:701-866-7050
Mailing Address - Fax:
Practice Address - Street 1:560 S MAPLE ST STE 30
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1759
Practice Address - Country:US
Practice Address - Phone:952-442-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14952363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical