Healthcare Provider Details

I. General information

NPI: 1962512376
Provider Name (Legal Business Name): GEORGE W THAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 S BREA CANYON RD STE F
DIAMOND BAR CA
91765-3481
US

IV. Provider business mailing address

PO BOX 4156
DIAMOND BAR CA
91765-0156
US

V. Phone/Fax

Practice location:
  • Phone: 909-860-3273
  • Fax: 909-860-7987
Mailing address:
  • Phone: 909-860-3273
  • Fax: 909-860-7987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number0172620
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number17262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: