Provider Demographics
NPI:1003121567
Name:THOMPSON, KIP (DC)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13025 SW MILLIKAN WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2562
Mailing Address - Country:US
Mailing Address - Phone:503-526-8782
Mailing Address - Fax:503-526-8721
Practice Address - Street 1:13025 SW MILLIKAN WAY
Practice Address - Street 2:STE 120
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2562
Practice Address - Country:US
Practice Address - Phone:503-526-8782
Practice Address - Fax:503-526-8721
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor