# TIESZEN CHIROPRACTIC CLINIC, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730206806
- **Authorized official:** DR. CHAD LANE TIESZEN D.C. (PRESIDENT)
- **Authorized official phone:** (605) 987-5577

## Contact information

- **Practice address:** 128 N DAKOTA ST, CANTON, SD 57013-1832
- **Practice address phone:** (605) 987-5577
- **Mailing address:** 128 N DAKOTA ST, PO BOX 224, CANTON, SD 57013-1832
- **Mailing address phone:** (605) 987-5577

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 912 | SD | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 07/25/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7600460 | — | SD |