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General NPI Number Information
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NPI Number | 1487617692
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Entity Type | Individual
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Provider Name | GAUTHAMA THOMPSON D.C., C.C.S.P.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 344 HANCOCK ST SUITE 1
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City | RUMFORD
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State | ME
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Zip | 04276-1937
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Country | US
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Telephone | 207-364-7931
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Fax | 207-364-3644
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Provider Business Mailing Address
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Address Line | 344 HANCOCK ST SUITE 1
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City | RUMFORD
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State | ME
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Zip | 04276-1937
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Country | US
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Telephone | 207-364-7931
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Fax | 207-364-3644
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CR1066
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | CR1066
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License Number State | ME
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