Provider Demographics
NPI:1215504212
Name:THOMAS J ORTH DC PC
Entity type:Organization
Organization Name:THOMAS J ORTH DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-650-1095
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:FORT PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57532-0253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 ISLAND DR STE 10
Practice Address - Street 2:
Practice Address - City:FORT PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57532-7301
Practice Address - Country:US
Practice Address - Phone:605-222-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty