Provider Demographics
NPI:1346577749
Name:THOMPSON, RENEE NICOLE (DC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MARBLE ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:VT
Mailing Address - Zip Code:05733-1120
Mailing Address - Country:US
Mailing Address - Phone:802-247-6464
Mailing Address - Fax:802-247-5615
Practice Address - Street 1:1616 N LITCHFIELD RD STE 250
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1298
Practice Address - Country:US
Practice Address - Phone:623-535-8661
Practice Address - Fax:623-535-8662
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0059714111N00000X
AZ8756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor