Provider Demographics
NPI:1972694784
Name:THORNHILL, STACY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:MARIE
Last Name:THORNHILL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14877 SUMTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4706
Mailing Address - Country:US
Mailing Address - Phone:952-226-5147
Mailing Address - Fax:
Practice Address - Street 1:3000 COUNTY ROAD 42 W
Practice Address - Street 2:SUITE 303
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4824
Practice Address - Country:US
Practice Address - Phone:952-226-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU92964Medicare UPIN