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General NPI Number Information
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NPI Number | 1093242125
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Entity Type | Organization
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Legal Business Name | THRIVE FAMILY CHIROPRACTIC AND NUTRITION, PLLC
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Dates
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Enumeration Date | 05/19/2017
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 6356 PHELAN BLVD
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City | BEAUMONT
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State | TX
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Zip | 77706-6150
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Country | US
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Telephone | 409-347-8606
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Fax | 409-420-3086
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Provider Business Mailing Address
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Address Line | 6356 PHELAN BLVD
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City | BEAUMONT
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State | TX
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Zip | 77706-6150
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Country | US
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Telephone | 409-347-8606
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Fax | 409-420-3086
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIFFANY A CORONADO
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Credential | DC, PHARM D
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Telephone | 409-347-8606
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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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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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