Healthcare Provider Details

I. General information

NPI: 1174890776
Provider Name (Legal Business Name): THIEDE CHIROPRACTIC, P.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2011
Last Update Date: 11/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 MERIDIAN AVE E SUITE #103
EDGEWOOD WA
98371-2190
US

IV. Provider business mailing address

2908 MERIDIAN AVE E SUITE #103
EDGEWOOD WA
98371-2190
US

V. Phone/Fax

Practice location:
  • Phone: 253-927-7721
  • Fax: 253-841-9390
Mailing address:
  • Phone: 253-927-7721
  • Fax: 253-841-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CONRAD THIEDE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 253-927-7721