Provider Demographics
NPI:1366631632
Name:CHIROPRACTIC REHAB CLINIC
Entity Type:Organization
Organization Name:CHIROPRACTIC REHAB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:660-385-1000
Mailing Address - Street 1:1604 GARY ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1936
Mailing Address - Country:US
Mailing Address - Phone:660-385-1000
Mailing Address - Fax:660-395-9229
Practice Address - Street 1:1604 GARY ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1936
Practice Address - Country:US
Practice Address - Phone:660-385-1000
Practice Address - Fax:660-395-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT43507Medicare UPIN