Provider Demographics
NPI:1154412369
Name:THURSTON, MARK A (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:THURSTON
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 1:806 HINES ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3022
Mailing Address - Country:US
Mailing Address - Phone:252-237-2166
Mailing Address - Fax:252-237-2167
Practice Address - Street 1:806 HINES ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3022
Practice Address - Country:US
Practice Address - Phone:252-237-2166
Practice Address - Fax:252-237-2167
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890883RMedicaid
NC0186UOtherBCBS GROUP
NC0883ROtherBCBSNC
NC890186UMedicaid
NC0883ROtherBCBSNC
NC0186UOtherBCBS GROUP
NC2453940Medicare PIN