MEDICARE: DR. CORY M THIELE D.C.

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	CH00034266	WA
2	111N00000X	Chiropractor	038.011478	IL
3	111N00000X	Chiropractor	3670	OR
4	111N00000X	Chiropractor	072217	IA

General Provider Information

NPI Number	:	1811062441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY M THIELE D.C.

Provider Business Mailing Address
First Line	:	5010 MILLS CIVIC PKWY STE 102
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-5267
Country	:	US
Telephone Number	:	515-777-9771
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 MILLS CIVIC PKWY STE 102
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-5267
Country	:	US
Telephone Number	:	515-777-9771
Fax Number	:

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/05/2014

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