Provider Demographics
NPI:1588000392
Name:THORN, JA'RE
Entity type:Individual
Prefix:
First Name:JA'RE
Middle Name:
Last Name:THORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12809 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-7403
Mailing Address - Country:US
Mailing Address - Phone:708-507-5511
Mailing Address - Fax:708-757-7145
Practice Address - Street 1:12809 S UNION AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-7403
Practice Address - Country:US
Practice Address - Phone:708-507-5511
Practice Address - Fax:708-757-7145
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist