Provider Demographics
NPI:1548906134
Name:THIEL, CHRISTOPHER RAY
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RAY
Last Name:THIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 N REDBUD CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-3215
Mailing Address - Country:US
Mailing Address - Phone:785-512-0248
Mailing Address - Fax:
Practice Address - Street 1:1701 E 23RD AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-9907
Practice Address - Country:US
Practice Address - Phone:620-513-4850
Practice Address - Fax:620-513-4851
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS15-02652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program