Healthcare Provider Details

I. General information

NPI: 1992848113
Provider Name (Legal Business Name): DENNIS PAUL TIEMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
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: 812-897-4640
Mailing address:
  • Phone: 812-897-4616
  • Fax: 812-897-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: