Provider Demographics
NPI:1205942687
Name:THORNE, ERIC P (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:THORNE
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 1:510 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001847-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16117654902OtherPRISM HEALTHNETWORK
NYDD4275Medicare PIN