Provider Demographics
NPI:1316936289
Name:FIEBIGER, TANYA SUE (DC)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:SUE
Last Name:FIEBIGER
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 1:3060 25TH ST S
Mailing Address - Street 2:STE. K
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6114
Mailing Address - Country:US
Mailing Address - Phone:701-232-8200
Mailing Address - Fax:701-232-8207
Practice Address - Street 1:3060 25TH ST S
Practice Address - Street 2:STE. K
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6114
Practice Address - Country:US
Practice Address - Phone:701-232-8200
Practice Address - Fax:701-232-8207
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4C938FIOtherEPNI BCBS MN
ND13735OtherBCBS ND
ND340144OtherCHIROPRACTIC CARE OF MN,
ND18869Medicaid
ND340144OtherCHIROPRACTIC CARE OF MN,
NDN70919Medicare ID - Type Unspecified