Provider Demographics
NPI:1780110098
Name:THORNTON, JARED KENT (DC)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:KENT
Last Name:THORNTON
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 1:870 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5296
Mailing Address - Country:US
Mailing Address - Phone:208-529-2044
Mailing Address - Fax:208-529-2032
Practice Address - Street 1:870 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-529-2044
Practice Address - Fax:208-529-2032
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor