Provider Demographics
NPI:1225112857
Name:THOMPSON, SHANDON JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANDON
Middle Name:JOSEPH
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 1:44121 HARRY BYRD HWY
Mailing Address - Street 2:#120
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5667
Mailing Address - Country:US
Mailing Address - Phone:703-777-1234
Mailing Address - Fax:703-777-8277
Practice Address - Street 1:44121 HARRY BYRD HWY
Practice Address - Street 2:#120
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5667
Practice Address - Country:US
Practice Address - Phone:703-777-1234
Practice Address - Fax:571-918-0760
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001181111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08949Medicare PIN