Provider Demographics
NPI:1336344001
Name:THORSON, SADIE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:MARIE
Last Name:THORSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:MARIE
Other - Last Name:RAUSENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3633 WINDTREE DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1319
Mailing Address - Country:US
Mailing Address - Phone:651-955-1083
Mailing Address - Fax:651-955-1083
Practice Address - Street 1:2115 COUNTY ROAD D E STE B
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-5353
Practice Address - Country:US
Practice Address - Phone:651-955-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000010162929OtherREGENCE BS OF IDAHO
WA8944683OtherCRIME VICTIMS OF WA
WA0222349OtherWASHINGTON L&I
WA7310RAOtherASURIS NW (BS OF WA)
WAFG8867723Medicare PIN