Provider Demographics
NPI:1568461630
Name:THESIER, WILLIAM ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROGER
Last Name:THESIER
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 1:240 MUSTANG TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7516
Mailing Address - Country:US
Mailing Address - Phone:757-486-3222
Mailing Address - Fax:757-498-7353
Practice Address - Street 1:240 MUSTANG TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7516
Practice Address - Country:US
Practice Address - Phone:757-486-3222
Practice Address - Fax:757-498-7353
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA075057OtherANTHEM BC / BS ID NUMBER
VA54-1352209OtherTAX ID NUMBER
VA54-1352209OtherTAX ID NUMBER
VA00V840T86Medicare ID - Type Unspecified