Provider Demographics
NPI:1912102963
Name:THIRY FAMILY CHIROPRACTIC SC
Entity Type:Organization
Organization Name:THIRY FAMILY CHIROPRACTIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:THIRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-849-7775
Mailing Address - Street 1:507 W MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1114
Mailing Address - Country:US
Mailing Address - Phone:608-849-7775
Mailing Address - Fax:
Practice Address - Street 1:507 W MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1114
Practice Address - Country:US
Practice Address - Phone:608-849-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1205809894OtherNPI
WI529730OtherDEAN CARE
WI=========010OtherBCBS
WI1205809894OtherNPI
WI529730OtherDEAN CARE