Individual
DR. KELLY RENEE THORNTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
8194 BYRON CENTER AVE SW, BYRON CENTER, MI 49315-9401
(616) 583-7810
(616) 583-0150
Mailing address
8194 BYRON CENTER AVE SW, BYRON CENTER, MI 49315-9401
(616) 583-7810
(616) 583-0150
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008969
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202066577
TAX IDENTIFICATION #
MI
01
—
950D114180
BLUE CROSS BLUE SHIELD
MI
Enumeration date
12/12/2006
Last updated
02/20/2008
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