Provider Demographics
NPI:1063676120
Name:THOMPSON, JESSICA ASHLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ASHLEY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 S LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2521
Mailing Address - Country:US
Mailing Address - Phone:248-787-7117
Mailing Address - Fax:
Practice Address - Street 1:418 S LOMBARD ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2521
Practice Address - Country:US
Practice Address - Phone:248-787-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6781111N00000X
NC4840111N00000X
MI2301009484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0F36387010Medicare UPIN