Provider Demographics
NPI:1295949881
Name:STRANDHOLT, THOR KNUT (DC)
Entity type:Individual
Prefix:DR
First Name:THOR
Middle Name:KNUT
Last Name:STRANDHOLT
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 1:3441 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2018
Mailing Address - Country:US
Mailing Address - Phone:916-485-6434
Mailing Address - Fax:916-485-0117
Practice Address - Street 1:3441 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2018
Practice Address - Country:US
Practice Address - Phone:916-485-6434
Practice Address - Fax:916-485-0117
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC011250Medicare ID - Type Unspecified
T04378Medicare UPIN