Provider Demographics
NPI:1427183680
Name:THORNTON, KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:THORNTON
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 1:529 DOLLY PARTON PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3600
Mailing Address - Country:US
Mailing Address - Phone:865-453-6161
Mailing Address - Fax:865-453-9538
Practice Address - Street 1:529 DOLLY PARTON PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3600
Practice Address - Country:US
Practice Address - Phone:865-453-6161
Practice Address - Fax:865-453-9538
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT86119Medicare UPIN
TN3675173Medicare ID - Type Unspecified