Healthcare Provider Details

I. General information

NPI: 1487598918
Provider Name (Legal Business Name): CHAZMON THORNTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CENTER ST LOT 2
BLANCHESTER OH
45107-1352
US

IV. Provider business mailing address

800 E CENTER ST LOT 2
BLANCHESTER OH
45107-1352
US

V. Phone/Fax

Practice location:
  • Phone: 937-238-0759
  • Fax:
Mailing address:
  • Phone: 937-238-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: