Provider Demographics
NPI:1891871562
Name:THRIVE CENTER OF THE GREEN MOUNTAINS INC
Entity Type:Organization
Organization Name:THRIVE CENTER OF THE GREEN MOUNTAINS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DONOHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-446-2499
Mailing Address - Street 1:P0 BOX 539
Mailing Address - Street 2:68 SOUTH MAIN ST THRIVE CENTER OF THE GREEN MOUNTAINS
Mailing Address - City:WALLINGFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05773-0539
Mailing Address - Country:US
Mailing Address - Phone:802-446-2499
Mailing Address - Fax:802-446-2508
Practice Address - Street 1:68 SOUTH MAIN ST
Practice Address - Street 2:THRIVE CENTER OF THE GREEN MOUNTAINS
Practice Address - City:WALLINGFORD
Practice Address - State:VT
Practice Address - Zip Code:05773-0539
Practice Address - Country:US
Practice Address - Phone:802-446-2499
Practice Address - Fax:802-446-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060001077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
49968OtherBCBS
556340OtherCIGNA
49968OtherBCBS