Individual
DR. MICK L. TIEGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
9455 35TH AVE SW, STE E, SEATTLE, WA 98126-3898
(206) 932-8320
(206) 932-6941
Mailing address
2301 N 36TH ST, BOISE, ID 83703-5207
(208) 331-3100
(208) 344-5277
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1056
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109367
LABOR & INDUSTRIES
WA
01
—
TI5132
REGENCE BLUE SHIELD
WA
Enumeration date
06/16/2005
Last updated
02/19/2008
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