Provider Demographics
NPI:1093242125
Name:THRIVE FAMILY CHIROPRACTIC AND NUTRITION, PLLC
Entity Type:Organization
Organization Name:THRIVE FAMILY CHIROPRACTIC AND NUTRITION, PLLC
Other - Org Name:THRIVE CHIROPRACTIC AND REGENERATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PHARM D
Authorized Official - Phone:409-347-8606
Mailing Address - Street 1:6356 PHELAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6150
Mailing Address - Country:US
Mailing Address - Phone:409-347-8606
Mailing Address - Fax:409-420-3086
Practice Address - Street 1:6356 PHELAN BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6150
Practice Address - Country:US
Practice Address - Phone:409-347-8606
Practice Address - Fax:409-420-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX587017OtherMEDICARE