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General NPI Number Information
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NPI Number | 1912102963
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Entity Type | Organization
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Legal Business Name | THIRY FAMILY CHIROPRACTIC SC
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 507 W MAIN ST STE C
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City | WAUNAKEE
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State | WI
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Zip | 53597-1114
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Country | US
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Telephone | 608-849-7775
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Fax |
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Provider Business Mailing Address
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Address Line | 507 W MAIN ST STE C
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City | WAUNAKEE
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State | WI
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Zip | 53597-1114
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Country | US
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Telephone | 608-849-7775
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. GREGORY G THIRY
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Credential | DC
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Telephone | 608-849-7775
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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 | 2265
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License Number State | WI
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