Provider Demographics
NPI:1659505329
Name:THORNTON CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:THORNTON CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-685-7107
Mailing Address - Street 1:906 LITHIA PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6121
Mailing Address - Country:US
Mailing Address - Phone:813-685-7107
Mailing Address - Fax:813-681-9693
Practice Address - Street 1:906 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6121
Practice Address - Country:US
Practice Address - Phone:813-685-7107
Practice Address - Fax:813-681-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22309OtherMEDICARE PTAN
FL350035028OtherRAILROAD MEDICARE PTAN
FLT94043Medicare UPIN