1821004052 NPI number — DR. MATTHEW EUGENE THIEL D.C.

Table of content: DR. MATTHEW EUGENE THIEL D.C. (NPI 1821004052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821004052 NPI number — DR. MATTHEW EUGENE THIEL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIEL
Provider First Name:
MATTHEW
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
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:
FITNESS INC.
Provider Other First Name:
WYANDOT CHIROPRACTIC
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CHIROPRACTOR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821004052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 HOUPT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43351-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-294-3489
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 HOUPT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43351-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-294-3489
Provider Business Practice Location Address Fax Number:
419-294-2791
Provider Enumeration Date:
07/31/2006

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:  1102 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 311516923 . This is a "COMMERCIAL CLAIMS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311516923 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 31151692300 . This is a "BWC PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2882911 . This is a "MEDICAID (GROUP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5840453 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000121332 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2795088 . This is a "MEDICAID-(INDIVIDUAL)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311516923 . This is a "FEDERAL TAX ID #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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