Provider Demographics
NPI:1326115973
Name:THORNE, CHARLES J (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:THORNE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3 NASHUA CT
Mailing Address - Street 2:SUITE H
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3133
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-4835
Practice Address - Street 1:3 NASHUA CT
Practice Address - Street 2:SUITE H
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3133
Practice Address - Country:US
Practice Address - Phone:410-933-5678
Practice Address - Fax:410-933-4835
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDS01189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT59615Medicare UPIN