Basic Information
| Provider Information | |||||||||
| NPI: | 1700170263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THARP | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | D.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1448 MARION WALDO RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433027422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403866580 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 491 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433024244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403866580 | ||||||||
| FaxNumber: | 7403866586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2011 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 4187 | OH | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 4187 | 05 | OH | MEDICAID |