Provider Demographics
NPI:1669864682
Name:TIEFEL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TIEFEL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:TIEFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-239-8844
Mailing Address - Street 1:5655 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1903
Mailing Address - Country:US
Mailing Address - Phone:317-672-9858
Mailing Address - Fax:
Practice Address - Street 1:5655 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1903
Practice Address - Country:US
Practice Address - Phone:317-672-9858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002747A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty