Provider Demographics
NPI:1871649681
Name:TIESZEN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TIESZEN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TIESZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-677-6345
Mailing Address - Street 1:PO BOX 112831
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-2831
Mailing Address - Country:US
Mailing Address - Phone:907-677-6345
Mailing Address - Fax:907-677-6604
Practice Address - Street 1:1310 E DIMOND BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2012
Practice Address - Country:US
Practice Address - Phone:907-677-6345
Practice Address - Fax:907-677-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK434227OtherSTATE BUSINESS LICENSE