Provider Demographics
NPI:1053497974
Name:THIELE, STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:THIELE
Suffix:
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 1:200 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4864
Mailing Address - Country:US
Mailing Address - Phone:203-204-2517
Mailing Address - Fax:860-643-9133
Practice Address - Street 1:200 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4864
Practice Address - Country:US
Practice Address - Phone:203-204-2517
Practice Address - Fax:860-643-9133
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6166581000OtherTAX NUMBER
CTCT4967OtherHEALTHNET
CT4219342OtherAETNA
CT050000577CT01OtherBLUECROSSBLUESHIELD
CT792118OtherCONNECTICARE
CT6166581000OtherTAX NUMBER