Provider Demographics
NPI:1356656615
Name:TLICEN, STEVEN LANDIS (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LANDIS
Last Name:TLICEN
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 1:2801 YULUPA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-9115
Mailing Address - Country:US
Mailing Address - Phone:707-542-4577
Mailing Address - Fax:707-542-4577
Practice Address - Street 1:2801 YULUPA AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-9115
Practice Address - Country:US
Practice Address - Phone:707-542-4577
Practice Address - Fax:707-542-4577
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor