Provider Demographics
NPI:1477804193
Name:THAYN, JOHN WILLIAM (DC, MS, BS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:THAYN
Suffix:
Gender:M
Credentials:DC, MS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39N 600E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-637-0450
Mailing Address - Fax:435-637-6341
Practice Address - Street 1:267 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2342
Practice Address - Country:US
Practice Address - Phone:435-259-0123
Practice Address - Fax:435-259-0126
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8399884-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor