1306832134 NPI number — TIMOTHY H IEHL D.C.

Table of content: TIMOTHY H IEHL D.C. (NPI 1306832134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306832134 NPI number — TIMOTHY H IEHL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IEHL
Provider First Name:
TIMOTHY
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306832134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/24/2006
NPI Reactivation Date:
03/31/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W9330 STATE ROAD 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54022-4319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-425-9091
Provider Business Mailing Address Fax Number:
715-425-7770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W9330 STATE ROAD 29
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVER FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54022-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-425-9091
Provider Business Practice Location Address Fax Number:
715-425-7770
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3048-012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3C835IE . This is a "BC/BS MN DOCTOR ID #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 490985 . This is a "ACN/CHIROCARE ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3C834IE . This is a "BC/BS MN OFFICE ID #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 32018700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391791107614 . This is a "BC/BS WI GROUP ID #" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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