MEDICARE: DR. MICHAEL THOMAS THIES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4426-012	WI

General Provider Information

NPI Number	:	1245494004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THOMAS THIES D.C.

Provider Business Mailing Address
First Line	:	4861 LARSON BEACH RD
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558
Country	:	US
Telephone Number	:	608-535-0355
Fax Number	:

Provider Business Practice Location Address
First Line	:	4861 LARSON BEACH RD
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-8735
Country	:	US
Telephone Number	:	608-535-0355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	01/10/2013

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