Provider Demographics
NPI:1871570457
Name:TIESZEN, KIMBERLY K (DC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:TIESZEN
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 1:1122 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3102
Mailing Address - Country:US
Mailing Address - Phone:719-859-1184
Mailing Address - Fax:
Practice Address - Street 1:1122 E FIRST ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3102
Practice Address - Country:US
Practice Address - Phone:719-859-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5C738KAOtherMINNESOTA BCBS
PATI374867OtherHIGHMARK BCBS
PA82571OtherGEISINGER HEALTH PLAN
MN5C738KAOtherMINNESOTA BCBS
PATI374867OtherHIGHMARK BCBS