MEDICARE: KIMBERLY K TIESZEN 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	CHR.0008064	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5C738KA	OTHER	MN	MINNESOTA BCBS
2	TI374867	OTHER	PA	HIGHMARK BCBS
3	82571	OTHER	PA	GEISINGER HEALTH PLAN

General Provider Information

NPI Number	:	1871570457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY K TIESZEN D.C.

Provider Business Mailing Address
First Line	:	1122 E FIRST ST
Second Line	:
City	:	TRINIDAD
State	:	CO
Zip	:	81082-3102
Country	:	US
Telephone Number	:	719-859-1184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 E FIRST ST
Second Line	:
City	:	TRINIDAD
State	:	CO
Zip	:	81082-3102
Country	:	US
Telephone Number	:	719-859-1184
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	06/06/2024

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1033106760 — STATE OF COLORADO
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Directions to “ KIMBERLY K TIESZEN D.C.” Practice Location

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