Provider Demographics
NPI:1881767341
Name:THORNTON, LOREN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:DOUGLAS
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 1:8761 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1106
Mailing Address - Country:US
Mailing Address - Phone:904-645-8778
Mailing Address - Fax:904-645-8728
Practice Address - Street 1:8761 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1106
Practice Address - Country:US
Practice Address - Phone:904-645-8778
Practice Address - Fax:904-645-8728
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70834YOtherMEDICARE ID
FLT55061Medicare UPIN