Healthcare Provider Details

I. General information

NPI: 1154335289
Provider Name (Legal Business Name): MICHAEL THOMPSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 BOONE VILLA DR
BOONVILLE MO
65233-1994
US

IV. Provider business mailing address

1951 BOONE VILLA DR
BOONVILLE MO
65233-1994
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-3333
  • Fax: 660-882-3323
Mailing address:
  • Phone: 660-882-3333
  • Fax: 660-882-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2002023866
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: