Provider Demographics
NPI:1083708846
Name:THATCHER, WILLIAM SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SAMUEL
Last Name:THATCHER
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 1:1050 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4201
Mailing Address - Country:US
Mailing Address - Phone:516-379-0424
Mailing Address - Fax:
Practice Address - Street 1:1050 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4201
Practice Address - Country:US
Practice Address - Phone:516-379-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX49611Medicare ID - Type Unspecified
NYU24704Medicare UPIN