MEDICARE: DR. JEREMY ERIC THOMPSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	CH9504	FL
2	111N00000X	Chiropractor	CH9504	FL

General Provider Information

NPI Number	:	1225213259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY ERIC THOMPSON D.C.

Provider Business Mailing Address
First Line	:	11707 TIERRA VERDE LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-1531
Country	:	US
Telephone Number	:	904-703-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	9726 TOUCHTON RD STE 301
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8307
Country	:	US
Telephone Number	:	904-772-6522
Fax Number	:	904-772-6553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	07/01/2020

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