Provider Demographics
NPI:1275737504
Name:THOMPSON, PAUL D (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
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 1:11 LITTLE CANADA RD E
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1322
Mailing Address - Country:US
Mailing Address - Phone:651-483-0898
Mailing Address - Fax:
Practice Address - Street 1:11 LITTLE CANADA RD E
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1322
Practice Address - Country:US
Practice Address - Phone:651-483-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0020970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN457327700Medicaid
MN29076THOtherBCBS
MN457327700Medicaid