Provider Demographics
NPI:1720190747
Name:THIELEN, PAUL WILLIAM (BS DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:THIELEN
Suffix:
Gender:M
Credentials:BS DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 SOUTH DAKOTA HWY 10
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2512
Mailing Address - Country:US
Mailing Address - Phone:605-698-3522
Mailing Address - Fax:605-698-4465
Practice Address - Street 1:1920 SOUTH DAKOTA HWY 10
Practice Address - Street 2:THIELEN CHIROPRACTIC CLINIC
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2512
Practice Address - Country:US
Practice Address - Phone:605-698-3522
Practice Address - Fax:605-698-4465
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN390728700OtherMEDICAL ASSISTANCE
SD7602742Medicaid
SD0003416OtherBLUE CROSS BLUE SHIELD
MN3C880THOtherBLUE CROSS BLUE SHIELD
0823OtherHEALTH SERVICE MANAGEMENT
410131OtherMEDICA
ND12612Medicaid
SD23433OtherSIOUX VALLEY HEALTH
SD7602742Medicaid
ND12612Medicaid