Provider Demographics
NPI:1487756987
Name:THORNTON, GREGORY THOMAS (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
Last Name:THORNTON
Suffix:
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 1:34521 UTICA RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-3576
Mailing Address - Country:US
Mailing Address - Phone:586-285-1090
Mailing Address - Fax:586-285-1099
Practice Address - Street 1:34521 UTICA RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3576
Practice Address - Country:US
Practice Address - Phone:586-285-1090
Practice Address - Fax:586-285-1099
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20301007597111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M59740Medicare ID - Type Unspecified
MIU70587Medicare UPIN