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Individual

DR. CONNIE THEISEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
9479 GARLAND AVE, MAPLE GROVE, MN 55311-5480
(763) 494-8787
Mailing address
12748 WALTER DR, ROGERS, MN 55374-5822
(763) 360-2405

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC4091
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
065473600
MN STATE AID
MN
01
078K2HE
BCBS MN
MN
01
112377
HEALTH PARTNERS
MN
01
44-00217
MEDICA
MN
Enumeration date
11/01/2006
Last updated
09/03/2008
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