Provider Demographics
NPI:1861672982
Name:THORNOCK, CHAD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:MICHAEL
Last Name:THORNOCK
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 1:1101 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA226047OtherWA STATE LABOR AND INDUSTRIES
WAG8869489Medicare PIN