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General NPI Number Information
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NPI Number | 1487946919
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Entity Type | Individual
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Provider Name | RUSSELL JOSEPH THOMPSON D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 629 CAMINO DE LOS MARES SUITE 104
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2834
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Country | US
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Telephone | 949-240-1334
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Fax | 949-240-4434
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Provider Business Mailing Address
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Address Line | 629 CAMINO DE LOS MARES SUITE 104
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2834
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Country | US
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Telephone | 949-240-1334
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Fax | 949-240-4434
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 31976
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License Number State | CA
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