Provider Demographics
NPI:1396700506
Name:THAYER, MARK W (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:THAYER
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 1:1103 ELLA ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4809
Mailing Address - Country:US
Mailing Address - Phone:864-226-6055
Mailing Address - Fax:864-226-6065
Practice Address - Street 1:1103 ELLA ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4809
Practice Address - Country:US
Practice Address - Phone:864-226-6055
Practice Address - Fax:864-226-6065
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1597Medicaid
SCCH1597Medicaid
SCU29548Medicare UPIN