Provider Demographics
NPI:1518966084
Name:THATCHER, MYRON WILLIAM III (DC)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:WILLIAM
Last Name:THATCHER
Suffix:III
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 1:1886 W STADIUM BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-7007
Mailing Address - Country:US
Mailing Address - Phone:734-663-2300
Mailing Address - Fax:734-663-0010
Practice Address - Street 1:1886 W STADIUM BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7007
Practice Address - Country:US
Practice Address - Phone:734-663-2300
Practice Address - Fax:734-663-0010
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI144389235Medicaid
MIT33626Medicare UPIN
MI144389235Medicaid