Individual
DR. CHAD LANE TIESZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
128 N DAKOTA ST, CANTON, SD 57013
(605) 987-5577
(605) 764-2020
Mailing address
PO BOX 224, CANTON, SD 57013
(605) 987-5577
(605) 764-2020
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
912
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0519793
—
IA
05
—
7600460
—
SD
Enumeration date
03/09/2006
Last updated
07/25/2012
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