Provider Demographics
NPI:1902093628
Name:THORNE CHIROPRACTIC OFFICE, PC
Entity Type:Organization
Organization Name:THORNE CHIROPRACTIC OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-694-3888
Mailing Address - Street 1:510 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4300
Mailing Address - Country:US
Mailing Address - Phone:716-694-3888
Mailing Address - Fax:716-694-3637
Practice Address - Street 1:510 OLIVER ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4300
Practice Address - Country:US
Practice Address - Phone:716-694-3888
Practice Address - Fax:716-694-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001847-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1498Medicare PIN