Provider Demographics
NPI:1053503052
Name:THOMPSON, RICHARD VERN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VERN
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 1:14133 S ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2635
Mailing Address - Country:US
Mailing Address - Phone:402-896-3312
Mailing Address - Fax:
Practice Address - Street 1:14133 S ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2635
Practice Address - Country:US
Practice Address - Phone:402-896-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250580-00Medicaid
NE100250580-00Medicaid