Healthcare Provider Details

I. General information

NPI: 1316146558
Provider Name (Legal Business Name): TIEMAN CHIROPRACTIC AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 4TH ST
BOONVILLE IN
47601-1806
US

IV. Provider business mailing address

202 S 4TH ST
BOONVILLE IN
47601-1806
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-4616
  • Fax:
Mailing address:
  • Phone: 812-897-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001912A
License Number StateIN

VIII. Authorized Official

Name: DR. DENNIS P TIEMAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 812-897-4616