Provider Demographics
NPI:1548307523
Name:THURSTON, GREGORY D (DC, DIBCN)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:THURSTON
Suffix:
Gender:M
Credentials:DC, DIBCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-0178
Mailing Address - Country:US
Mailing Address - Phone:847-477-7678
Mailing Address - Fax:847-573-1944
Practice Address - Street 1:1614 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4302
Practice Address - Country:US
Practice Address - Phone:847-477-7678
Practice Address - Fax:847-573-1944
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005346111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology