=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518106335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL C THRONEBURG N.B.C., H.I.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2009
-----------------------------------------------------
Last Update Date | 02/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4229 14TH ST W
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34205-6009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-748-9800
-----------------------------------------------------
Fax | 941-748-9807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4229 14TH ST W
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34205-6009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-748-9800
-----------------------------------------------------
Fax | 941-748-9807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS1609
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------