Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC12558A | CA |
NPI | 1578695649 |
---|---|
Provider Name | Dr. Jeffrey Lorrell Thurston |
First Address | Northridge, CA 91324-2310 |
Second Address | Northridge, CA 91324-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 03/04/2009 |