Healthcare Provider Details

I. General information

NPI: 1659357895
Provider Name (Legal Business Name): KATHY THORN D.C., D.A.C.B.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851A DURHAM RD
WAKE FOREST NC
27587-8793
US

IV. Provider business mailing address

851A DURHAM RD
WAKE FOREST NC
27587-8793
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-6570
  • Fax:
Mailing address:
  • Phone: 919-562-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number2160
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: