Healthcare Provider Details

I. General information

NPI: 1659343952
Provider Name (Legal Business Name): MICHAEL S. THOMPSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 LAFAYETTE AVE
BELLEVUE KY
41073-1333
US

IV. Provider business mailing address

549 LAFAYETTE AVE
BELLEVUE KY
41073-1333
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-4430
  • Fax: 859-431-9560
Mailing address:
  • Phone: 859-431-4430
  • Fax: 859-431-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4268
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: