MEDICARE: DR. THEA MARIE FEIERABEND DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5731	MN

General Provider Information

NPI Number	:	1679811194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEA MARIE FEIERABEND DC

Provider Business Mailing Address
First Line	:	311 W WASHINGTON ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-2923
Country	:	US
Telephone Number	:	218-454-3015
Fax Number	:	218-454-3016

Provider Business Practice Location Address
First Line	:	311 W WASHINGTON ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-2923
Country	:	US
Telephone Number	:	218-454-3015
Fax Number	:	218-454-3016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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