MEDICARE: THIGPEN CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1063186708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THIGPEN CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	3520 WALTON WAY EXT STE 1A
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6591
Country	:	US
Telephone Number	:	706-917-3169
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 WALTON WAY EXT STE 1A
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6591
Country	:	US
Telephone Number	:	706-917-3169
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BEAU EDWIN THIGPEN
Credential	:	D.C., B.C.A.O.
Telephone Number	:	404-394-2191

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	08/05/2021

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