Provider Demographics
NPI:1902116411
Name:TIERI, BRENT EDWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:EDWIN
Last Name:TIERI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13324 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4540
Mailing Address - Country:US
Mailing Address - Phone:763-568-7869
Mailing Address - Fax:763-568-7872
Practice Address - Street 1:13324 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4540
Practice Address - Country:US
Practice Address - Phone:763-568-7869
Practice Address - Fax:763-568-7872
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor