Provider Demographics
NPI:1841543410
Name:THEIS, RACHEL MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARIE
Last Name:THEIS
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 1:879 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5871
Mailing Address - Country:US
Mailing Address - Phone:651-503-8298
Mailing Address - Fax:
Practice Address - Street 1:879 MONTEREY DR
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5871
Practice Address - Country:US
Practice Address - Phone:651-503-8298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor