Provider Demographics
NPI:1750814760
Name:THORASSIC PARK
Entity Type:Organization
Organization Name:THORASSIC PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:O'MEARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-758-1402
Mailing Address - Street 1:1603 60TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4658
Mailing Address - Country:US
Mailing Address - Phone:941-727-8739
Mailing Address - Fax:
Practice Address - Street 1:1603 60TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4658
Practice Address - Country:US
Practice Address - Phone:941-727-8739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty