Provider Demographics
NPI:1093993982
Name:PERRIER, THANE JEROME (DC)
Entity Type:Individual
Prefix:DR
First Name:THANE
Middle Name:JEROME
Last Name:PERRIER
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 1:214 S ROCK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1161
Mailing Address - Country:US
Mailing Address - Phone:316-687-5362
Mailing Address - Fax:316-678-5365
Practice Address - Street 1:214 S ROCK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1161
Practice Address - Country:US
Practice Address - Phone:316-687-5362
Practice Address - Fax:316-678-5365
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-01729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS062480OtherBLUE CROSS BLUE SHIELD
KS062480OtherBLUE CROSS BLUE SHIELD