Healthcare Provider Details

I. General information

NPI: 1780777888
Provider Name (Legal Business Name): JEFFEREY THOMPSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 TAYLOR BLVD
LOUISVILLE KY
40215-2341
US

IV. Provider business mailing address

901 PARK AVE
IRONTON OH
45638-1529
US

V. Phone/Fax

Practice location:
  • Phone: 502-333-0604
  • Fax: 502-290-9734
Mailing address:
  • Phone: 740-523-8888
  • Fax: 740-532-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number249422
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: