Provider Demographics
NPI:1205826963
Name:TIESZEN, DEAN F (DC)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:F
Last Name:TIESZEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N BROADWAY
Mailing Address - Street 2:PO BOX 178
Mailing Address - City:MARION
Mailing Address - State:SD
Mailing Address - Zip Code:57043-0178
Mailing Address - Country:US
Mailing Address - Phone:605-648-3761
Mailing Address - Fax:605-648-3580
Practice Address - Street 1:203 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SD
Practice Address - Zip Code:57043-0178
Practice Address - Country:US
Practice Address - Phone:605-648-3761
Practice Address - Fax:605-648-3580
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T66538Medicare UPIN
SDS86193Medicare ID - Type Unspecified