Healthcare Provider Details

I. General information

NPI: 1629258702
Provider Name (Legal Business Name): THOMPSON CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 PIONEER ST STE A
ENUMCLAW WA
98022-2299
US

IV. Provider business mailing address

1624 PIONEER ST. STE. A
ENUMCLAW WA
98022-2299
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-5757
  • Fax: 360-825-5784
Mailing address:
  • Phone: 360-825-5757
  • Fax: 360-825-5784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number3013
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAB26203
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerMEDICARE DR#

VIII. Authorized Official

Name: DR. DANIEL BRIGHTON THOMPSON
Title or Position: OWNER/DOCTOR
Credential: DC
Phone: 360-825-5757