Healthcare Provider Details

I. General information

NPI: 1336118827
Provider Name (Legal Business Name): DAVID RILEY THOMSEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HAVENDALE BLVD NW
WINTER HAVEN FL
33881-5302
US

IV. Provider business mailing address

1400 HAVENDALE BLVD NW
WINTER HAVEN FL
33881-5302
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-3109
  • Fax: 863-293-0078
Mailing address:
  • Phone: 863-294-3109
  • Fax: 863-293-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 7537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: