Provider Demographics
NPI:1336729235
Name:THENARD, PAUL III (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:THENARD
Suffix:III
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 1:4543 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3154
Mailing Address - Country:US
Mailing Address - Phone:714-404-7306
Mailing Address - Fax:
Practice Address - Street 1:4543 IDAHO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-3154
Practice Address - Country:US
Practice Address - Phone:714-404-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor