Provider Demographics
NPI:1598235517
Name:THORNTON FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:THORNTON FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-529-2044
Mailing Address - Street 1:870 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5296
Mailing Address - Country:US
Mailing Address - Phone:208-529-2044
Mailing Address - Fax:208-529-2032
Practice Address - Street 1:870 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5296
Practice Address - Country:US
Practice Address - Phone:208-529-2044
Practice Address - Fax:208-529-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty