Provider Demographics
NPI:1619026614
Name:THIESING, STEPHEN C (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:THIESING
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 1:506 N GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3220
Mailing Address - Country:US
Mailing Address - Phone:931-490-0606
Mailing Address - Fax:931-490-0634
Practice Address - Street 1:506 N GARDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3220
Practice Address - Country:US
Practice Address - Phone:931-490-0606
Practice Address - Fax:931-490-0634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621768467OtherTAX ID NUMBER
TNU75826Medicare UPIN
TN3970588Medicare ID - Type Unspecified