Provider Demographics
NPI:1598990913
Name:TIETZE, PATRICK ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ANTHONY
Last Name:TIETZE
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 1:5353 GRAND HAVEN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5985
Mailing Address - Country:US
Mailing Address - Phone:231-798-9355
Mailing Address - Fax:231-799-1777
Practice Address - Street 1:5353 GRAND HAVEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5985
Practice Address - Country:US
Practice Address - Phone:231-798-9355
Practice Address - Fax:231-799-1777
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor