Provider Demographics
NPI:1700186921
Name:TIERI CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:TIERI CHIROPRACTIC, LLC
Other - Org Name:TOTAL SPINE HEALTH AND INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:TIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-913-9410
Mailing Address - Street 1:13324 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4540
Mailing Address - Country:US
Mailing Address - Phone:763-568-7869
Mailing Address - Fax:763-568-7872
Practice Address - Street 1:13324 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4540
Practice Address - Country:US
Practice Address - Phone:763-568-7869
Practice Address - Fax:763-568-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty