Provider Demographics
NPI:1396875449
Name:LAYTON, THADDEUS JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:JAMES
Last Name:LAYTON
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:PO BOX 440036
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160-9501
Mailing Address - Country:US
Mailing Address - Phone:770-955-2011
Mailing Address - Fax:678-819-1240
Practice Address - Street 1:1226 FRANKLIN RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8702
Practice Address - Country:US
Practice Address - Phone:770-955-2011
Practice Address - Fax:678-819-1240
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1978111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation