Provider Demographics
NPI:1366262743
Name:THIBODEAU, JOHN-MICHAEL II (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN-MICHAEL
Middle Name:
Last Name:THIBODEAU
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-6519
Mailing Address - Country:US
Mailing Address - Phone:401-575-1771
Mailing Address - Fax:
Practice Address - Street 1:2525 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2214
Practice Address - Country:US
Practice Address - Phone:401-738-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor