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General NPI Number Information
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NPI Number | 1184975179
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Entity Type | Organization
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Legal Business Name | KEVIN R THORPE LLC
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 1475 PALM COAST PKWY NW SUITE 103
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City | PALM COAST
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State | FL
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Zip | 32137-4735
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Country | US
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Telephone | 386-986-1823
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Fax | 386-986-1924
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Provider Business Mailing Address
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Address Line | 1475 PALM COAST PKWY NW SUITE 103
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City | PALM COAST
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State | FL
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Zip | 32137-4735
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN ROBERT THORPE
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Credential | D.C.
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Telephone | 386-405-1299
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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 | CH9340
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License Number State | FL
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