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General NPI Number Information
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NPI Number | 1497750350
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Entity Type | Individual
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Provider Name | MICK L. TIEGS D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 9455 35TH AVE SW STE E
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City | SEATTLE
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State | WA
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Zip | 98126-3898
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Country | US
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Telephone | 206-932-8320
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Fax | 206-932-6941
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Provider Business Mailing Address
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Address Line | 2301 N 36TH ST
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City | BOISE
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State | ID
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Zip | 83703-5207
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Country | US
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Telephone | 208-331-3100
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Fax | 208-344-5277
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-1056
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License Number State | ID
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