Provider Demographics
NPI:1114982006
Name:THOMPSON, LEE ERIK (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ERIK
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:HEALTHY
Other - Middle Name:
Other - Last Name:CREATIONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6727 W STATE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-7423
Mailing Address - Country:US
Mailing Address - Phone:208-853-2277
Mailing Address - Fax:
Practice Address - Street 1:6727 W STATE ST STE 130
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-7423
Practice Address - Country:US
Practice Address - Phone:208-853-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010022893OtherREGENCE
ID002738600Medicaid
IDC-730-9OtherBLUE CROSS
ID000010022893OtherREGENCE
IDC-730-9OtherBLUE CROSS