Provider Demographics
NPI:1306832134
Name:IEHL, TIMOTHY H (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:H
Last Name:IEHL
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:W9330 STATE ROAD 29
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4319
Mailing Address - Country:US
Mailing Address - Phone:715-425-9091
Mailing Address - Fax:715-425-7770
Practice Address - Street 1:W9330 STATE ROAD 29
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-4319
Practice Address - Country:US
Practice Address - Phone:715-425-9091
Practice Address - Fax:715-425-7770
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
WI3048-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C835IEOtherBC/BS MN DOCTOR ID #
490985OtherACN/CHIROCARE ID #
MN3C834IEOtherBC/BS MN OFFICE ID #
WI32018700Medicaid
WI391791107614OtherBC/BS WI GROUP ID #
WI32018700Medicaid
U47481Medicare UPIN