Individual
DR. JUSTIN KEITH THORPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD,DC
Contact information
Practice address
300 W OAK ST STE 200, CARBONDALE, IL 62901-1400
(618) 536-0221
(618) 252-2540
Mailing address
300 W OAK ST STE 200, CARBONDALE, IL 62901-1400
(618) 536-0221
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
038-010493
IL
207Q00000X
Family Medicine Physician
Primary
125.080018
IL
207Q00000X
Family Medicine Physician
125080018
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038010493
—
IL
01
—
134314368
TAX ID
IL
01
—
744343
HEALTHLINK
IL
01
—
8332029
BCBS OF IL
IL
01
—
P00314027
PIN
IL
Enumeration date
10/23/2006
Last updated
11/02/2023
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