Provider Demographics
NPI:1538235049
Name:THILL, LAWRENCE J (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:THILL
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 1:6205 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8930
Mailing Address - Country:US
Mailing Address - Phone:916-652-7373
Mailing Address - Fax:
Practice Address - Street 1:6205 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8930
Practice Address - Country:US
Practice Address - Phone:916-652-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22183111N00000X
CA22183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor