Provider Demographics
NPI:1205907813
Name:THILLE, MICHAEL P (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:THILLE
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 1:117 NW LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1322
Mailing Address - Country:US
Mailing Address - Phone:541-548-4014
Mailing Address - Fax:541-548-0544
Practice Address - Street 1:117 NW LARCH AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1322
Practice Address - Country:US
Practice Address - Phone:541-548-4014
Practice Address - Fax:541-548-0544
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2309111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR058771001OtherBLUE CROSS
OR122507OtherOMAP
OR0000WFBWTBMedicare ID - Type UnspecifiedMEDICARE
OR122507OtherOMAP
OR058771001OtherBLUE CROSS
OR350043436Medicare ID - Type UnspecifiedRAILROAD