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General NPI Number Information
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NPI Number | 1063186708
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Entity Type | Organization
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Legal Business Name | THIGPEN CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 3520 WALTON WAY EXT STE 1A
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City | AUGUSTA
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State | GA
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Zip | 30909-6591
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Country | US
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Telephone | 706-917-3169
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 WALTON WAY EXT STE 1A
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City | AUGUSTA
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State | GA
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Zip | 30909-6591
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Country | US
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Telephone | 706-917-3169
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BEAU EDWIN THIGPEN
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Credential | D.C., B.C.A.O.
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Telephone | 404-394-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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