Provider Demographics
NPI:1437220092
Name:FIELDS, THADIUS RYON (DC)
Entity Type:Individual
Prefix:
First Name:THADIUS
Middle Name:RYON
Last Name:FIELDS
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 1:1302 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-1692
Mailing Address - Country:US
Mailing Address - Phone:308-728-5551
Mailing Address - Fax:308-728-7951
Practice Address - Street 1:135 N 15TH ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1404
Practice Address - Country:US
Practice Address - Phone:308-728-5551
Practice Address - Fax:308-728-7951
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09708OtherBCBS #
NE15154OtherMIDLAND'S CHOICE#
NE09708OtherBCBS #
NE47082530200Medicare ID - Type Unspecified