Provider Demographics
NPI:1326112251
Name:THORNQUIST, THOMAS ARTHUR (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ARTHUR
Last Name:THORNQUIST
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 1:9201 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-3514
Mailing Address - Country:US
Mailing Address - Phone:763-780-8249
Mailing Address - Fax:763-780-8249
Practice Address - Street 1:9201 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-3514
Practice Address - Country:US
Practice Address - Phone:763-780-8249
Practice Address - Fax:763-780-8249
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39978Medicare UPIN