MEDICARE: BOU & THOMPSON FAMILY CHIROPRACTIC CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1306801873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOU & THOMPSON FAMILY CHIROPRACTIC CARE PLLC

Provider Business Mailing Address
First Line	:	242 JERICHO TPKE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-2147
Country	:	US
Telephone Number	:	516-328-9015
Fax Number	:	516-488-9865

Provider Business Practice Location Address
First Line	:	242 JERICHO TPKE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-2147
Country	:	US
Telephone Number	:	516-328-9015
Fax Number	:	516-488-9865

Authorized Official
Title or Position	:	MEMBER OF PLLC
Name	:	DR. JENNIFER MELISSA THOMPSON
Credential	:	DC
Telephone Number	:	516-328-9015

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	08/22/2020

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