Provider Demographics
NPI:1073934535
Name:JESSICA DAWN THOMPSON, INC.
Entity Type:Organization
Organization Name:JESSICA DAWN THOMPSON, INC.
Other - Org Name:CAFE' OF LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-772-8311
Mailing Address - Street 1:202 MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6080
Mailing Address - Country:US
Mailing Address - Phone:303-772-8311
Mailing Address - Fax:303-827-3657
Practice Address - Street 1:202 MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6080
Practice Address - Country:US
Practice Address - Phone:303-772-8311
Practice Address - Fax:303-827-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1073691812OtherINDIVIDUAL NPI NUMBER