Doctor Name: | DR. CONNIE THEISEN |
NPI Number: | 1063599892 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | DC4091 |
Business Practice Address: | 9479 Garland Ave Maple Grove, MN - 553115480 |
Business Phone Number: | 7634948787 |
Business Fax Number: | |
Mailing Address: | 12748 Walter Dr, ROGERS |
State: | MN |
Postal Code: | 553745822 |
Phone Number: | 7633602405 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 09/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | DC4091 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |