Organization
DR. MICK L. TIEGS, INC., PS
Active
Organization
DR. MICK L. TIEGS, INC., PS
Active
Other names
Northside Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICK L. TIEGS D.C. (DOCTOR OF CHIROPRACTIC)
(208) 571-8418
Entity
Organization
Contact information
Practice address
2301 N 36TH ST, BOISE, ID 83703-5207
(208) 571-8418
(208) 344-5277
Mailing address
2301 N 36TH ST, BOISE, ID 83703-5207
(208) 571-8418
(208) 344-5277
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
3119
WA
261QH0100X
Health Service Clinic/Center
Primary
CHIA-1056
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497750350
NPI-INDIVIDUAL
WA
Enumeration date
02/22/2007
Last updated
02/04/2008
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