Provider Demographics
NPI:1497750350
Name:TIEGS, MICK L (DC)
Entity Type:Individual
Prefix:DR
First Name:MICK
Middle Name:L
Last Name:TIEGS
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 1:2301 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5207
Mailing Address - Country:US
Mailing Address - Phone:208-331-3100
Mailing Address - Fax:208-344-5277
Practice Address - Street 1:9455 35TH AVE SW
Practice Address - Street 2:STE E
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3898
Practice Address - Country:US
Practice Address - Phone:206-932-8320
Practice Address - Fax:206-932-6941
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA109367OtherLABOR & INDUSTRIES
WATI5132OtherREGENCE BLUE SHIELD
WATI5132OtherREGENCE BLUE SHIELD