Provider Demographics
NPI:1720112980
Name:THAYN, MILTON KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:KENNETH
Last Name:THAYN
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 1:39 N 600 E
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-2624
Mailing Address - Country:US
Mailing Address - Phone:435-637-0450
Mailing Address - Fax:435-637-6341
Practice Address - Street 1:39 N 600 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2624
Practice Address - Country:US
Practice Address - Phone:435-637-0450
Practice Address - Fax:435-637-6341
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT156186-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870304778OtherFEDERAL ID NUMBER