Individual
DR. KENNETH LEO THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
430 SOUTH BROAD ST, SUITE 130, MANKATO, MN 56001
(507) 387-5591
(507) 387-5397
Mailing address
430 SOUTH BROAD ST, SUITE 130, MANKATO, MN 56001
(507) 387-5591
(507) 387-5397
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1375
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
788725600
—
MN
Enumeration date
10/25/2006
Last updated
09/15/2010
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