Provider Demographics
NPI:1104988989
Name:MONGIE, THOR PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:THOR
Middle Name:PATRICK
Last Name:MONGIE
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 1:2 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2239
Mailing Address - Country:US
Mailing Address - Phone:702-417-8522
Mailing Address - Fax:
Practice Address - Street 1:2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651
Practice Address - Country:US
Practice Address - Phone:702-417-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00981111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology