Provider Demographics
NPI:1447558978
Name:THEIGE, CHASE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:LEE
Last Name:THEIGE
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 1:717 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6166
Mailing Address - Country:US
Mailing Address - Phone:701-577-2472
Mailing Address - Fax:
Practice Address - Street 1:717 E BROADWAY
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-6166
Practice Address - Country:US
Practice Address - Phone:701-577-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor