Provider Demographics
NPI:1467571760
Name:THORSEN, SCOTT W (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:THORSEN
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:PO BOX 774
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97528-0066
Mailing Address - Country:US
Mailing Address - Phone:541-476-4010
Mailing Address - Fax:541-474-6310
Practice Address - Street 1:1328 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1225
Practice Address - Country:US
Practice Address - Phone:541-476-4010
Practice Address - Fax:541-474-6310
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-05-20
Deactivation Date:2019-04-25
Deactivation Code:
Reactivation Date:2019-05-20
Provider Licenses
StateLicense IDTaxonomies
OR272954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR101502Medicare UPIN