Provider Demographics
NPI:1518977362
Name:THIRY, ROBERT E (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:THIRY
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 1:501 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5925
Mailing Address - Country:US
Mailing Address - Phone:208-375-0007
Mailing Address - Fax:208-658-0578
Practice Address - Street 1:501 W GROVE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5925
Practice Address - Country:US
Practice Address - Phone:208-375-0007
Practice Address - Fax:208-658-0578
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor