Individual
PAIGE DETHORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
8690 W PAHS RD, MICHIGAN CITY, IN 46360-7666
(219) 872-5151
(219) 872-0177
Mailing address
8690 W PAHS RD, MICHIGAN CITY, IN 46360-7666
(219) 872-5151
(219) 872-0177
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08003196A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08003196A
STATE LICENSE
IN
Enumeration date
11/19/2020
Last updated
11/19/2020
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