Healthcare Provider Details

I. General information

NPI: 1992854475
Provider Name (Legal Business Name): BRADLEY D THOMPSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 HARNEY ST
SAN DIEGO CA
92110-2828
US

IV. Provider business mailing address

4062 HARNEY ST
SAN DIEGO CA
92110-2828
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-9355
  • Fax:
Mailing address:
  • Phone: 619-297-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number18979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: