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General NPI Number Information
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NPI Number | 1972615995
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Entity Type | Organization
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Legal Business Name | LEAH M THIELEN
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 1920 SOUTH DAKOTA HWY 10
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City | SISSETON
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State | SD
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Zip | 57262-2512
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Country | US
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Telephone | 605-698-3522
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Fax | 605-698-4465
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Provider Business Mailing Address
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Address Line | 1920 SOUTH DAKOTA HWY 10
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City | SISSETON
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State | SD
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Zip | 57262-2512
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Country | US
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Telephone | 605-698-3522
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Fax | 605-698-4465
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Authorized Official
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Title or Position | OWNER
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Name | LEAH MEYER THIELEN
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Credential | DC
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Telephone | 605-698-3522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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