Provider Demographics
NPI:1093932022
Name:THOMPSON, DEAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:J
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 1:45 MITCHELL BLVD.
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903
Mailing Address - Country:US
Mailing Address - Phone:415-492-2225
Mailing Address - Fax:415-492-2227
Practice Address - Street 1:45 MITCHELL BLVD.
Practice Address - Street 2:SUITE 9
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-492-2225
Practice Address - Fax:415-492-2227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC016221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor