Provider Demographics
NPI:1811062441
Name:THIELE, CORY M (DC)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:M
Last Name:THIELE
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 1:5010 MILLS CIVIC PKWY STE 102
Mailing Address - Street 2:
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 STE 102
Practice Address - Street 2:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034266111N00000X
IL038.011478111N00000X
OR3670111N00000X
IA072217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor