Provider Demographics
NPI:1447082284
Name:SCHAEFER, THOR JASON (DC)
Entity type:Individual
Prefix:
First Name:THOR
Middle Name:JASON
Last Name:SCHAEFER
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 1:119 TRUXTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2460
Mailing Address - Country:US
Mailing Address - Phone:850-862-4313
Mailing Address - Fax:850-863-1765
Practice Address - Street 1:119 TRUXTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2460
Practice Address - Country:US
Practice Address - Phone:850-862-4313
Practice Address - Fax:850-863-1765
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor