Healthcare Provider Details

I. General information

NPI: 1902029788
Provider Name (Legal Business Name): HOWARD COLEMAN THOMPSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46641 N BLACK CANYON HWY STE 10
NEW RIVER AZ
85087-6941
US

IV. Provider business mailing address

46641 N BLACK CANYON HWY STE 10
NEW RIVER AZ
85087-6941
US

V. Phone/Fax

Practice location:
  • Phone: 623-465-1012
  • Fax:
Mailing address:
  • Phone: 623-465-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: