Provider Demographics
NPI:1447399555
Name:THORN, CHRISTINE M (DC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:THORN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:800 WOODTICK RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2521
Mailing Address - Country:US
Mailing Address - Phone:203-879-3111
Mailing Address - Fax:
Practice Address - Street 1:800 WOODTICK RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2521
Practice Address - Country:US
Practice Address - Phone:203-879-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
050000932CT01OtherBCBS
CT000932OtherCT LICENSE
350000776Medicare ID - Type Unspecified