Provider Demographics
NPI:1073642617
Name:THATCHER CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:THATCHER CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-663-2300
Mailing Address - Street 1:1886 W STADIUM BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-7007
Mailing Address - Country:US
Mailing Address - Phone:734-663-2300
Mailing Address - Fax:734-663-0010
Practice Address - Street 1:1886 W STADIUM BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7007
Practice Address - Country:US
Practice Address - Phone:734-663-2300
Practice Address - Fax:734-663-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33626Medicare UPIN
MI0H1500Medicare PIN