Provider Demographics
NPI:1720386048
Name:THORNOCK CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:THORNOCK CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:THORNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-839-5656
Mailing Address - Street 1:1101 TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2264
Mailing Address - Country:US
Mailing Address - Phone:509-839-5656
Mailing Address - Fax:509-839-5682
Practice Address - Street 1:1101 TACOMA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2264
Practice Address - Country:US
Practice Address - Phone:509-839-5656
Practice Address - Fax:509-839-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty