Provider Demographics
NPI:1164595138
Name:THIELEN, LEAH MEYER (DC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MEYER
Last Name:THIELEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 SOUTH DAKOTA HWY 10
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2512
Mailing Address - Country:US
Mailing Address - Phone:605-698-3522
Mailing Address - Fax:605-698-4465
Practice Address - Street 1:1920 SOUTH DAKOTA HWY 10
Practice Address - Street 2:THIELEN CHIROPRACTIC CLINIC
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2512
Practice Address - Country:US
Practice Address - Phone:605-698-3522
Practice Address - Fax:605-698-4465
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD702111N00000X
MN2179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD23430OtherSIOUX VALLEY HEALTH
9003OtherHEALTH SERVICE MGR
SD0003415OtherBLUECROSS BLUESHIELD
MN150828800OtherMEDICAL ASSISTANCE
410130OtherMEDICA
SD7602732Medicaid
ND12610OtherMEDICAID
MN3C879THOtherBLUECROSS BLUESHIELD
T66208Medicare UPIN
9003OtherHEALTH SERVICE MGR