Provider Demographics
NPI:1548368194
Name:THOLE, JUSTIN W (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:W
Last Name:THOLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 REDWING RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6321
Mailing Address - Country:US
Mailing Address - Phone:970-377-1810
Mailing Address - Fax:
Practice Address - Street 1:2627 REDWING RD
Practice Address - Street 2:SUITE 235
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6321
Practice Address - Country:US
Practice Address - Phone:970-377-1810
Practice Address - Fax:970-377-1815
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV07770Medicare UPIN