Provider Demographics
NPI:1992848113
Name:TIEMAN, DENNIS PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PAUL
Last Name:TIEMAN
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 1:202 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-1806
Mailing Address - Country:US
Mailing Address - Phone:812-897-4616
Mailing Address - Fax:812-897-4640
Practice Address - Street 1:202 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-1806
Practice Address - Country:US
Practice Address - Phone:812-897-4616
Practice Address - Fax:812-897-4640
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001912A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000223139OtherANTHEM PIN
IN000000223139OtherANTHEM PIN
INU82707Medicare UPIN