Provider Demographics
NPI:1588963540
Name:THACKER, DOLPHUS ALLEN III (DC)
Entity type:Individual
Prefix:DR
First Name:DOLPHUS
Middle Name:ALLEN
Last Name:THACKER
Suffix:III
Gender:M
Credentials:DC
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Mailing Address - Street 1:5410 PAGE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8230
Mailing Address - Country:US
Mailing Address - Phone:919-474-8400
Mailing Address - Fax:919-947-8486
Practice Address - Street 1:5410 PAGE RD
Practice Address - Street 2:STE 3
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8230
Practice Address - Country:US
Practice Address - Phone:919-474-8400
Practice Address - Fax:919-947-8486
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2016-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC4182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor