Provider Demographics
NPI:1770589483
Name:TIERNEY, CATHERINE ANN (DC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 BRADY ST
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-1089
Mailing Address - Country:US
Mailing Address - Phone:989-845-3223
Mailing Address - Fax:
Practice Address - Street 1:1223 BRADY ST
Practice Address - Street 2:
Practice Address - City:CHESANING
Practice Address - State:MI
Practice Address - Zip Code:48616-1089
Practice Address - Country:US
Practice Address - Phone:989-845-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005697111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NT0100XChiropractic ProvidersChiropractorThermography
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3102176Medicaid
MI950G35056OtherBCBS PROVIDERNUMBER
MI3102176Medicaid
MI950G35056OtherBCBS PROVIDERNUMBER