Provider Demographics
NPI:1215032289
Name:THOMPSON, BRUCE TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TODD
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 1:6270 W ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5526
Mailing Address - Country:US
Mailing Address - Phone:254-770-1505
Mailing Address - Fax:254-770-1525
Practice Address - Street 1:6270 W ADAMS AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5526
Practice Address - Country:US
Practice Address - Phone:254-770-1505
Practice Address - Fax:254-770-1525
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0020927Medicaid
TX0020927Medicaid
TXU77178Medicare UPIN