Provider Demographics
NPI:1861264970
Name:THIEDE, JOSHUA WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WILLIAM
Last Name:THIEDE
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 1:1034 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1310
Mailing Address - Country:US
Mailing Address - Phone:715-785-5006
Mailing Address - Fax:715-785-5190
Practice Address - Street 1:1034 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1310
Practice Address - Country:US
Practice Address - Phone:715-785-5006
Practice Address - Fax:715-785-5190
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6128-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor