Provider Demographics
NPI:1841347929
Name:THORNTON, JOHN A (IDC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:THORNTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21284 BREVIK PL NW
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6642
Mailing Address - Country:US
Mailing Address - Phone:360-731-0274
Mailing Address - Fax:
Practice Address - Street 1:21284 BREVIK PL NW
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6642
Practice Address - Country:US
Practice Address - Phone:360-731-0274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman