Provider Demographics
NPI:1093992083
Name:PACKARD HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PACKARD HEALTH SERVICES, LLC
Other - Org Name:THORNTON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALLAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-268-1386
Mailing Address - Street 1:10988 COMBIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8987
Mailing Address - Country:US
Mailing Address - Phone:530-268-1386
Mailing Address - Fax:
Practice Address - Street 1:10988 COMBIE RD STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8987
Practice Address - Country:US
Practice Address - Phone:530-268-1386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33888261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000056381OtherINDIVIDUAL MEDICARE NUMBE
UT000058112OtherGROUP MEDICARE NUMBER