Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 27-2309 | OR |
NPI | 1205907813 |
---|---|
Provider Name | Dr. Michael P Thille |
First Address | Redmond, OR 97756-1322 |
Second Address | Redmond, OR 97756-1322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058771001 | BLUE CROSS (01) | OR |
122507 | OMAP (01) | OR |
T68184 | (02) | OR |