Provider Demographics
NPI:1851428619
Name:THAYER, DOUGLAS WARREN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WARREN
Last Name:THAYER
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 1:189 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5303
Mailing Address - Country:US
Mailing Address - Phone:315-797-4222
Mailing Address - Fax:315-797-7644
Practice Address - Street 1:189 CLINTON RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5303
Practice Address - Country:US
Practice Address - Phone:315-797-4222
Practice Address - Fax:315-797-7644
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161531371TH1OtherBC BS NUMBER
NYC08587-OBOtherWORKERS' COMP. NUMBER
NYU65889Medicare UPIN
NYC08587-OBOtherWORKERS' COMP. NUMBER