Provider Demographics
NPI:1104885730
Name:THAYER, GABRIEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:JOHN
Last Name:THAYER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 110
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076
Mailing Address - Country:US
Mailing Address - Phone:860-684-2227
Mailing Address - Fax:860-684-6104
Practice Address - Street 1:72 WEST STAFFORD ROAD
Practice Address - Street 2:SUITE A-3
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076
Practice Address - Country:US
Practice Address - Phone:860-684-2227
Practice Address - Fax:860-684-6104
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001272OtherANTHEM BC/BS
CT004225167Medicaid
CTCT001471OtherHMC PPO NORTHEAST HEALTH
CT9353973OtherPHCS
CTCT001471OtherHEALTH NET
CT3320173OtherAETNA
CT5551126OtherCCN NETWORK
CT668802OtherACN GROUP
CT775301OtherCONNECTICARE
CTP2809094OtherOXFORD HEALTH PLANS
CT2240832OtherFIRST HEALTH
CT350001272Medicare ID - Type Unspecified
CT004225167Medicaid
CT2240832OtherFIRST HEALTH