Provider Demographics
NPI:1386786333
Name:THIESSE, TIFFANY DOT (DC)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:DOT
Last Name:THIESSE
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 1:605 S IOWA ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-3836
Mailing Address - Country:US
Mailing Address - Phone:605-990-2225
Mailing Address - Fax:605-990-2235
Practice Address - Street 1:1224 N SANBORN BLVD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1347
Practice Address - Country:US
Practice Address - Phone:605-990-2225
Practice Address - Fax:605-990-2235
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor