Healthcare Provider Details

I. General information

NPI: 1740886175
Provider Name (Legal Business Name): ADRIAN P THANE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 WASHINGTON ST STE C
CLARKESVILLE GA
30523-6028
US

IV. Provider business mailing address

475 WASHINGTON ST STE C
CLARKESVILLE GA
30523-6028
US

V. Phone/Fax

Practice location:
  • Phone: 706-839-1005
  • Fax:
Mailing address:
  • Phone: 706-839-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO010823
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: