Provider Demographics
NPI:1205081171
Name:THREDE CHIROPRACTIC, INC
Entity type:Organization
Organization Name:THREDE CHIROPRACTIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:THREDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-939-2224
Mailing Address - Street 1:1908 OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5023
Mailing Address - Country:US
Mailing Address - Phone:925-939-2224
Mailing Address - Fax:925-939-7683
Practice Address - Street 1:1908 OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5023
Practice Address - Country:US
Practice Address - Phone:925-939-2224
Practice Address - Fax:925-939-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA228272DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0228720Medicare UPIN