Provider Demographics
NPI:1093896532
Name:THORNLEY, TISH A (RN DC)
Entity Type:Individual
Prefix:MS
First Name:TISH
Middle Name:A
Last Name:THORNLEY
Suffix:
Gender:F
Credentials:RN DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2642
Mailing Address - Country:US
Mailing Address - Phone:987-281-5225
Mailing Address - Fax:978-281-8789
Practice Address - Street 1:221 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2642
Practice Address - Country:US
Practice Address - Phone:978-281-5225
Practice Address - Fax:978-281-8789
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1396111N00000X
MEME252767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA723255OtherTUFTS
MA1609173Medicaid
MA1609173Medicaid