Provider Demographics
NPI:1740886175
Name:THANE, ADRIAN P (DC)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:P
Last Name:THANE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 BANKS ST
Mailing Address - Street 2:
Mailing Address - City:LULA
Mailing Address - State:GA
Mailing Address - Zip Code:30554-2858
Mailing Address - Country:US
Mailing Address - Phone:678-649-8569
Mailing Address - Fax:
Practice Address - Street 1:6110 BANKS ST
Practice Address - Street 2:
Practice Address - City:LULA
Practice Address - State:GA
Practice Address - Zip Code:30554-2858
Practice Address - Country:US
Practice Address - Phone:678-203-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO010823111NS0005X, 111N00000X
GASTUDENT-0244982390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program