Healthcare Provider Details

I. General information

NPI: 1083722706
Provider Name (Legal Business Name): WADE C THOMPSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 W 13400 S STE 200
HERRIMAN UT
84065-6953
US

IV. Provider business mailing address

5734 W 13400 S STE 200
HERRIMAN UT
84065-6953
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-6220
  • Fax: 801-446-2166
Mailing address:
  • Phone: 801-446-6220
  • Fax: 801-446-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4916781-1202
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: