Provider Demographics
NPI:1447243415
Name:THEIS, KARL D (DC)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:D
Last Name:THEIS
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 1:6525 MARKET AVE N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:N CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2430
Mailing Address - Country:US
Mailing Address - Phone:330-433-9000
Mailing Address - Fax:330-433-9026
Practice Address - Street 1:6525 MARKET AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:N CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2430
Practice Address - Country:US
Practice Address - Phone:330-433-9000
Practice Address - Fax:330-433-9026
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854197Medicaid
OHU27898Medicare UPIN
OH0854197Medicaid