Healthcare Provider Details

I. General information

NPI: 1235994302
Provider Name (Legal Business Name): SHAWN EDWIN THORNTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 W 4TH AVE
FLINT MI
48503-2404
US

IV. Provider business mailing address

3092 DURANT HTS
GRAND BLANC MI
48507-4514
US

V. Phone/Fax

Practice location:
  • Phone: 810-496-5500
  • Fax:
Mailing address:
  • Phone: 810-516-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: