Healthcare Provider Details

I. General information

NPI: 1699754630
Provider Name (Legal Business Name): QUENTIN O THOMPSON I DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W HAVENS ST
MITCHELL SD
57301-4334
US

IV. Provider business mailing address

501 WEST HAVENS AVENUE
MITCHELL SD
57301
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-1078
  • Fax: 605-996-3703
Mailing address:
  • Phone: 605-996-1078
  • Fax: 605-996-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number862
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: