Individual provider Active NPI

Tyler Douglas Theis, DC

  • Chiropractor
  • Little Falls, MN
National Provider Identifier
1427880368
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
7261 Issued in MN
Practice address
109 5TH St NE # 1/2
Little Falls, MN 56345-2732
Phone
(320) 632-9224
Fax
(320) 632-6303
NPI assigned
Aug 19, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 7261 MN Primary

Addresses

Primary practice location

109 5TH St NE # 1/2
Little Falls, MN 56345-2732

Mailing address

109 5TH St NE # 1/2
Little Falls, MN 56345-2732
Phone (320) 632-9224

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240917001838 MN Practitioner - Chiropractic 0941741060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mason Orth PC MNGroup PAC ID 3577742576, 2 clinicians

Practice addresses (Care Compare)

113 4TH St NE
Suite 1
Little Falls, MN 56345-2719
Phone (320) 632-9224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7261MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mason Orth PC MN Chiropractor CurrentSince Aug 1, 2024 Accepting new patients

Locations

109 5th St NE
#12
Little Falls, MN 56345
Phone (320) 632-9224

113 4th St NE
Ste 1
Little Falls, MN 56345
Phone (320) 632-9224

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1427880368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 5TH ST NE # 1/2",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563452732",
            "telephone_number": "320-632-9224",
            "fax_number": "320-632-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 5TH ST NE # 1/2",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563452732",
            "telephone_number": "320-632-9224",
            "fax_number": "320-632-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "TYLER",
        "middle_name": "DOUGLAS",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "7261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.