Provider Demographics
NPI:1063273589
Name:KIESCHNICK, TATUM J (DC)
Entity type:Individual
Prefix:DR
First Name:TATUM
Middle Name:J
Last Name:KIESCHNICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:TATUM
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3480 FANNIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3804
Mailing Address - Country:US
Mailing Address - Phone:409-832-7776
Mailing Address - Fax:
Practice Address - Street 1:3480 FANNIN ST STE C
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3804
Practice Address - Country:US
Practice Address - Phone:409-832-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor