Provider Demographics
NPI:1235230301
Name:KEMPER, THOMAS LEO (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEO
Last Name:KEMPER
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 1:1450 25TH ST S
Mailing Address - Street 2:STE: 157
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8105
Mailing Address - Country:US
Mailing Address - Phone:701-241-9355
Mailing Address - Fax:701-451-9137
Practice Address - Street 1:1450 25TH ST S
Practice Address - Street 2:STE: 157
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8105
Practice Address - Country:US
Practice Address - Phone:701-241-9355
Practice Address - Fax:701-451-9137
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10754Medicaid
ND10754Medicaid
ND16078Medicare ID - Type Unspecified