MEDICARE: THIELE CHIROPRACTIC & WELLNESS, LLC

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	261Q00000X	Clinic/Center	072217	IA

General Provider Information

NPI Number	:	1255755880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THIELE CHIROPRACTIC & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	5010 MILLS CIVIC PKWY
Second Line	:	STE. 102
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-5267
Country	:	US
Telephone Number	:	515-777-9771
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 MILLS CIVIC PKWY
Second Line	:	STE. 102
City	:	WEST DES MOINES
State	:	IA
Zip	:	50265-5267
Country	:	US
Telephone Number	:	515-777-9771
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. CORY MICHAEL THIELE
Credential	:	DC
Telephone Number	:	360-601-7610

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	02/18/2014

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