Provider Demographics
NPI:1184932634
Name:THORN, SHIRLEY LYNN (LMT,HHP,CHI)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LYNN
Last Name:THORN
Suffix:
Gender:F
Credentials:LMT,HHP,CHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 QUAIL XING
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3688
Mailing Address - Country:US
Mailing Address - Phone:541-441-1084
Mailing Address - Fax:
Practice Address - Street 1:1441 QUAIL XING
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3688
Practice Address - Country:US
Practice Address - Phone:541-441-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10903204D00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM