Provider Demographics
NPI:1114018330
Name:THOMPSON, GEORGE WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
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 1:49 MTN LODGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-2014
Mailing Address - Country:US
Mailing Address - Phone:845-497-2225
Mailing Address - Fax:845-497-2225
Practice Address - Street 1:49 MTN LODGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-2014
Practice Address - Country:US
Practice Address - Phone:845-497-2225
Practice Address - Fax:845-497-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX49691Medicare ID - Type UnspecifiedMEDICARE #
NYU31902Medicare UPIN