Provider Demographics
NPI:1144361361
Name:BEE, THANE
Entity type:Individual
Prefix:DR
First Name:THANE
Middle Name:
Last Name:BEE
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 1:1042 BERYL TRL
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3922
Mailing Address - Country:US
Mailing Address - Phone:937-776-8475
Mailing Address - Fax:
Practice Address - Street 1:6 SYCAMORE CREEK DR # B
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-2300
Practice Address - Country:US
Practice Address - Phone:937-748-0001
Practice Address - Fax:937-748-8099
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC. 2352111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH656160OtherUHC PIN NUMBER
OH000000319375OtherANTHEM PIN NUMBER
OHBE0814533Medicare ID - Type Unspecified
OH656160OtherUHC PIN NUMBER