Provider Demographics
NPI:1427880368
Name:THEIS, TYLER DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:DOUGLAS
Last Name:THEIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 5TH ST NE # 1/2
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-2732
Mailing Address - Country:US
Mailing Address - Phone:320-632-9224
Mailing Address - Fax:320-632-6303
Practice Address - Street 1:109 5TH ST NE # 1/2
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-2732
Practice Address - Country:US
Practice Address - Phone:320-632-9224
Practice Address - Fax:320-632-6303
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor