Provider Demographics
NPI:1962512376
Name:THAN, GEORGE W (DC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:THAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4156
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-0156
Mailing Address - Country:US
Mailing Address - Phone:909-860-3273
Mailing Address - Fax:909-860-7987
Practice Address - Street 1:3220 S BREA CANYON RD STE F
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3481
Practice Address - Country:US
Practice Address - Phone:909-860-3273
Practice Address - Fax:909-860-7987
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0172620111NI0013X
CA17262111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17262Medicare PIN