Gabriel John Thayer, D.C.
Individual provider Active NPI Chiropractor · Stafford Springs, CT
NPI 1104885730 · NPPES record last updated Feb 12, 2014
Key facts
- NPI
- 1104885730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 001471 (CT)
- Practice address
- 72 West Stafford Road
Suite a-3
Stafford Springs, CT 06076 - Phone
- (860) 684-2227
- Fax
- (860) 684-6104
- NPI assigned
- Mar 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
72 W Stafford Rd
Unit A3
Stafford Springs, CT 06076-1082
Phone (860) 684-2227
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080606000700 | CT | Practitioner - Chiropractic | 8527138213 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001471 | CT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stafford Family Chiropractic, LLC | Chiropractor | Current |
Accepting new patients |
Locations
72 W Stafford Rd
Unit A3
Stafford Springs, CT 06076
Phone (860) 684-2227
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 001471 | CT | Yes |
Addresses
Primary practice location
72 West Stafford Road
Suite a-3
Stafford Springs, CT 06076
Mailing address
P.O. Box 110
Stafford Springs, CT 06076
Phone (860) 684-2227
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350001272 | Other | CT | ANTHEM BC/BS |
| 004225167 | Medicaid | CT | |
| CT001471 | Other | CT | HMC PPO NORTHEAST HEALTH |
| 9353973 | Other | CT | PHCS |
| CT001471 | Other | CT | HEALTH NET |
| 3320173 | Other | CT | AETNA |
| 5551126 | Other | CT | CCN NETWORK |
| 668802 | Other | CT | ACN GROUP |
| 775301 | Other | CT | CONNECTICARE |
| P2809094 | Other | CT | OXFORD HEALTH PLANS |
| 2240832 | Other | CT | FIRST HEALTH |
Other providers in Stafford Springs, CT
- Stafford Public Schools
- Stafford Springs CT SNF LLC
- Desirae Tabor-Bannister
- Naufel Tajudeen
- Terry M. Eccles, MD, LLC
- The Treehouse Center for Children and Families, LLC
- Time to Thrive Therapy Services, LLC
- Town of Stafford
- Town of Stafford - Stafford Family Services
- Stephanie Tullock
All providers in Stafford Springs, CT · Chiropractor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.