=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033307301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOMERVILLE CHIROPRACTIC CENTER PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 WASHINGTON VALLEY RD
-----------------------------------------------------
City | MARTINSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08836-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-560-1979
-----------------------------------------------------
Fax | 732-356-6333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 232
-----------------------------------------------------
City | MARTINSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08836-0232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-560-1979
-----------------------------------------------------
Fax | 732-356-6333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KENNETH W THORN
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 732-560-1979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 01470
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------