Provider Demographics
NPI:1154965473
Name:THIELEN, CASSANDRA (DC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:THIELEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19506 U ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4211
Mailing Address - Country:US
Mailing Address - Phone:402-981-4792
Mailing Address - Fax:
Practice Address - Street 1:18010 R PLZ STE 104
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1923
Practice Address - Country:US
Practice Address - Phone:402-408-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor