Provider Demographics
NPI:1205809894
Name:THIRY, GREGORY G (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:THIRY
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 1:1223 W MAIN ST # 292
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1942
Mailing Address - Country:US
Mailing Address - Phone:608-373-1563
Mailing Address - Fax:
Practice Address - Street 1:1223 W MAIN ST # 292
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1942
Practice Address - Country:US
Practice Address - Phone:608-886-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2852411Medicaid
WI391776539010OtherBCBS
WI391776539010OtherBCBS
WI2852411Medicaid