Provider Demographics
NPI:1295720415
Name:THIELGES, DAVID KEITH (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KEITH
Last Name:THIELGES
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 1:11 TRIPP ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7343
Mailing Address - Country:US
Mailing Address - Phone:541-773-7710
Mailing Address - Fax:
Practice Address - Street 1:11 TRIPP ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7343
Practice Address - Country:US
Practice Address - Phone:541-773-7710
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR225235Medicaid
OR0000QGCDCMedicare ID - Type Unspecified