Provider Demographics
NPI:1811029515
Name:THORNTON, ALPHEUS MARTIN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ALPHEUS
Middle Name:MARTIN
Last Name:THORNTON
Suffix:JR
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 1:1650 MONMOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9726
Mailing Address - Country:US
Mailing Address - Phone:503-838-3346
Mailing Address - Fax:503-838-3346
Practice Address - Street 1:1650 MONMOUTH STREET
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-9726
Practice Address - Country:US
Practice Address - Phone:503-838-3346
Practice Address - Fax:503-838-3346
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150836Medicaid
OR150836Medicaid
OR100637Medicare ID - Type Unspecified