Healthcare Provider Details

I. General information

NPI: 1891901252
Provider Name (Legal Business Name): GAUTHAMA THOMPSON, RIVER VALLEY CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 HANCOCK ST SUITE 1
RUMFORD ME
04276-1937
US

IV. Provider business mailing address

344 HANCOCK ST SUITE 1
RUMFORD ME
04276-1937
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-7931
  • Fax: 207-364-3644
Mailing address:
  • Phone: 207-364-7931
  • Fax: 207-364-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR1066
License Number StateME

VIII. Authorized Official

Name: DR. GAUTHAMA THOMPSON
Title or Position: PRESIDENT
Credential: DC
Phone: 207-364-7931