Provider Demographics
NPI:1679811194
Name:FEIERABEND, THEA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:MARIE
Last Name:FEIERABEND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2923
Mailing Address - Country:US
Mailing Address - Phone:218-454-3015
Mailing Address - Fax:218-454-3016
Practice Address - Street 1:311 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2923
Practice Address - Country:US
Practice Address - Phone:218-454-3015
Practice Address - Fax:218-454-3016
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor