Provider Demographics
NPI:1497885701
Name:THATCHER, TERRY THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:THOMAS
Last Name:THATCHER
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 1:1710 CROGHAN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2759
Mailing Address - Country:US
Mailing Address - Phone:419-332-6351
Mailing Address - Fax:419-332-6351
Practice Address - Street 1:1710 CROGHAN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2759
Practice Address - Country:US
Practice Address - Phone:419-332-6351
Practice Address - Fax:419-332-6351
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341105462OtherTAXPAYER ID NUMBER
OH000000127369OtherANTHEM BLUE CROSS
OH341105462-003OtherMEDICAL MUTUAL OF OHIO
OHANTHEM BLUE CROSSOtherANTHEM BLUE CROSS
OHTH0390741Medicare ID - Type Unspecified