Provider Demographics
NPI:1962828665
Name:THIEM, JOSEPH (DC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:THIEM
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 1:1000 SCOTIA DR
Mailing Address - Street 2:UNIT 403
Mailing Address - City:HYPOLUXO
Mailing Address - State:FL
Mailing Address - Zip Code:33462-7036
Mailing Address - Country:US
Mailing Address - Phone:612-559-6782
Mailing Address - Fax:
Practice Address - Street 1:1814 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6641
Practice Address - Country:US
Practice Address - Phone:561-582-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor