Provider Demographics
NPI:1427241702
Name:JEFFREY L. THURSTON CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:JEFFREY L. THURSTON CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LORRELL
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-701-9900
Mailing Address - Street 1:9535 RESEDA BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2310
Mailing Address - Country:US
Mailing Address - Phone:818-701-9900
Mailing Address - Fax:
Practice Address - Street 1:9535 RESEDA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2310
Practice Address - Country:US
Practice Address - Phone:818-701-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12558261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC12558AMedicare PIN