Provider Demographics
NPI:1659357895
Name:THORN, KATHY (DC, DACBR)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:THORN
Suffix:
Gender:F
Credentials:DC, DACBR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851A DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8793
Mailing Address - Country:US
Mailing Address - Phone:919-562-6570
Mailing Address - Fax:
Practice Address - Street 1:851A DURHAM RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8793
Practice Address - Country:US
Practice Address - Phone:919-562-6570
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2160111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08817OtherBLUE CROSS BLUE SHIELD
NC2449755AMedicare ID - Type Unspecified
NCU70339Medicare UPIN