Provider Demographics
NPI:1063672459
Name:DEAN E. THORNTON, DC, PC
Entity Type:Organization
Organization Name:DEAN E. THORNTON, DC, PC
Other - Org Name:THORNTON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-283-6043
Mailing Address - Street 1:401 STEPHENSON ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-2244
Mailing Address - Country:US
Mailing Address - Phone:912-283-6043
Mailing Address - Fax:912-283-6043
Practice Address - Street 1:401 STEPHENSON ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-2244
Practice Address - Country:US
Practice Address - Phone:912-283-6043
Practice Address - Fax:912-283-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006348261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU75916Medicare UPIN
GA35ZCHDMMedicare PIN