Provider Demographics
NPI:1184606741
Name:THORNE, GARY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:THORNE
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 1:517 BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4424
Mailing Address - Country:US
Mailing Address - Phone:910-323-5522
Mailing Address - Fax:910-483-9497
Practice Address - Street 1:517 BEAUMONT RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4424
Practice Address - Country:US
Practice Address - Phone:910-323-5522
Practice Address - Fax:910-483-9497
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08878OtherBLUE CROSS BLUE SHIELD
NC89013GNMedicaid
NC8908878Medicaid
NC013GNOtherBCBS GROUP
NC08878OtherBLUE CROSS BLUE SHIELD
NC2447555AMedicare ID - Type Unspecified
NC8908878Medicaid