Provider Demographics
NPI:1255755880
Name:THIELE CHIROPRACTIC & WELLNESS, LLC
Entity type:Organization
Organization Name:THIELE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THIELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-601-7610
Mailing Address - Street 1:5010 MILLS CIVIC PKWY
Mailing Address - Street 2:STE. 102
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5267
Mailing Address - Country:US
Mailing Address - Phone:515-777-9771
Mailing Address - Fax:
Practice Address - Street 1:5010 MILLS CIVIC PKWY
Practice Address - Street 2:STE. 102
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-5267
Practice Address - Country:US
Practice Address - Phone:515-777-9771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072217261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center