Provider Demographics
NPI:1356541700
Name:THORNTON CHIROPRACTIC LIFE CENTER, PA
Entity type:Organization
Organization Name:THORNTON CHIROPRACTIC LIFE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:THORNTON
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-638-8121
Mailing Address - Street 1:2404 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4424
Mailing Address - Country:US
Mailing Address - Phone:252-638-8121
Mailing Address - Fax:252-633-3401
Practice Address - Street 1:2404 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4424
Practice Address - Country:US
Practice Address - Phone:252-638-8121
Practice Address - Fax:252-633-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890837NMedicaid
NC0837NOtherBCBS
NC890837NMedicaid